Name * First Name Last Name Email * Phone * (###) ### #### How did you hear about this kit? * Name and age of your child * This kit is suitable for children aged 2-5 only. Your form will be invalid if you do not indicate the age of your child. The kits can only be picked-up. * Do you agree that if you are unable to pick the kit up by the specified date we will give them away to other families that are on our waiting list? YES No Thank you! Please make note of the pick up date from July 02-July 05 anytime before 4:30PM(weekdays) before 3:00PM(weekend) We’re excited to get your kit to you.Let’s get you signed up!
