Submit Club Facilitator Registration

Registering to start a Kids Care Club is easy. Fill out and submit the following registration form. Kids Care Clubs will review your application and contact you to initiate your membership. Once you are a registered club, you will be given a user name and password.

You must be 18 years of age to start a Kids Care Club.

* indicates a required field

Just a few more questions...

Would you be willing to serve as a resource to other Kids Care Clubs or share information regarding your club with others, including the media?: *

Yes

What are the specific needs of the community that this club is addressing?:

Any additional comments?:

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