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Kids & Youth - Sign Me Up

First Name   Initial   Last Name  
Address (Street # & Name)  
Additional Space (& Apt #)  
City   Province ONTARIO
Postal Code   Country CANADA
Home Phone #  (            ) Cell Phone #  (            )
Male or Female   Date of Birth  
e-Mail Address  
My Signature & Agreement to the Rules of the Card  
Date of Signature   I am between 6 and 18 years old: My Age  
I go to school (Y/N) Grade I work (full-time/part-time/not/or want to)  

With my signature above, I understand that I must follow the guidelines of event providers, and understand that negative behaviour or my lack of adhering to the rules at these activities can negate my privilege to be a KPYO member, and whereby I would forfeit my collected reward points which would be cancelled on the basis of breach of this agreement.

I am a parent/legal guardian of the above applicant, and agree/approve this application for the Points Card.

First Name   Last Name  
Emergency #  (            ) Bus Phone #  (            )
e-Mail Address  
My Signature & understanding of the Rules for my Applicant  
Could you volunteer? (Y/N) If so, in what capacity and what is your availability? Thank you for playing your part for our next generation...  

The above application is for a Rewards Card for kids aged 6 through youth 18 only.  KPYO Card Members will be awarded points for participating in activities with organizers that accept the Points Card around the GTA.  Members will be able to redeem the points for retail products & services from the on-line Catalogue after 6 months of membership.

 Earning while learning for a bright future…


KidsPlay & YouthOutlook

Tel & Fax: 416-813-0909    345 Bloor Street East, Box 72533 , Toronto , ON M4W 3S9 Canada   Toll Free 1-877-762-7624

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