First Name*
 
Last Name*
 
Address*
 
City*
 
State*
 
Zip Code*
 

Please provide at least two phone numbers.
Home Phone #
Your Cell Phone #
Other Phone#

Grade* (in Fall 2014)
 
School* (in Fall 2014)
 

Have you been a Kid Power volunteer before?*
 
What years?

    * required