Family Membership Commitment Form

Name

First Name

Last Name

Do you give 100 Kids Kawartha Lakes permission to contact you via email?

Yes

Name of Child #1 (Last name only required if different from parent)

First Name

Last Name

Age

Name of Child #2 (Last name only required if different from parent)

First Name

Last Name

Age

Name of Child #3 (Last name only required if different from parent)

First Name

Last Name

Age

I give permission to 100 Kids Kawartha Lakes to use photos that myself and my children are in for web content, advertising, etc. I understand that my name will only be used in conjunction with my photo if my submitted charity is drawn/successfully selected.

Yes, please

No, thank you

* I understand that by clicking submit, I am making a commitment to 100 Kids Kawartha Lakes to make a donation of $10 per child two times per year, which will be given directly to local charities, non-profits and organizations benefiting the City of Kawartha Lakes. I agree to fulfill my donation commitment even if my children did not vote for the charity selected by majority vote.

Family Membership Commitment Form

100 Kids Who Care

Kawartha Lakes