Kids Club Membership

Welcome to the Kids Club! Your child will have access to 4 new art video tutorials each month and you will also be able to connect with me and other parents in our private Facebook group.

Child's Information

Child's Name {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Membership Type  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Parent / Guardian Information

Parent/Guardian Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Payment Information 

Bank Information for Direct Deposit 

Account Name: Natalia Jones 

Bank: Republic Bank Ltd. 

Account Number: 940 000 003 301

Description: Kids Art Club 

OR 

Account Name : Mark or Natalia Jones 

Bank: Royal Bank 

Account Number: 110000004174009 

Description: Kids Art Club 

Kids Club Membership

Child's Information

Child's Name {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Child's Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Comments or Questions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Membership Type  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Parent / Guardian Information

Parent/Guardian Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Relationship to Child {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Contact's Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Alternate number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Payment Information 

Bank Information for Direct Deposit 

Account Name: Natalia Jones 

Bank: Republic Bank Ltd. 

Account Number: 940 000 003 301

Description: Kids Art Club 

OR 

Account Name : Mark or Natalia Jones 

Bank: Royal Bank 

Account Number: 110000004174009 

Description: Kids Art Club 

Kids Club Membership

Welcome to the Kids Club! Your child will have access to 4 new art video tutorials each month and you will also be able to connect with me and other parents in our private Facebook group.

Child's Information

Child's Name {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Child's Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Comments or Questions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Membership Type  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Parent / Guardian Information

Parent/Guardian Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Relationship to Child {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Contact's Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Alternate number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Payment Information 

Bank Information for Direct Deposit 

Account Name: Natalia Jones 

Bank: Republic Bank Ltd. 

Account Number: 940 000 003 301

Description: Kids Art Club 

OR 

Account Name : Mark or Natalia Jones 

Bank: Royal Bank 

Account Number: 110000004174009 

Description: Kids Art Club 

Cognito Forms{{ Cognito.resources["powered-by-cognito"] }}