Wildcat Kids Club Application - Pearl River CC

Thank you for your interest in signing up for Pearl River Community College's Wildcat Kids Club. Please take a few minutes to fill out the information below!

PARENT DETAILS

Are you the child's parent or guardian? *

Only a parent or guardian is allowed to apply

ZIP Code *

Email address *

Cell Phone Number *

City *

Address 1 *

Last name *

State *

First name *

CHILD 1 INFORMATION

First name *

Last name *

Please select a gender *

Please select grade *

What is child's birthday? (MM/DD/YYYY) *

What is your child's favorite sport? *

What are your child's favorite subjects in school? *

What is your child's favorite color? *

Select shirt size *

CHILD 2 INFORMATION

First name

Last name

Please select a gender

Please select grade

What is child's birthday? (MM/DD/YYYY)

What is your child's favorite sport?

What are your child's favorite subjects in school?

What is your child's favorite color?

Select shirt size

CHILD 3 INFORMATION

First name

Last name

Please select a gender

Please select grade

What is child's birthday? (MM/DD/YYYY)

What is your child's favorite sport?

What are your child's favorite subjects in school?

What is your child's favorite color?

Select shirt size

CHILD 4 INFORMATION

First name

Last name

Please select a gender

Please select grade

What is child's birthday? (MM/DD/YYYY)

What is your child's favorite sport?

What are your child's favorite subjects in school?

What is your child's favorite color?

Select shirt size

* required field