Alpha Kids

Registration Form

Building Future Leaders

Program Categories

Leadership

Health & Home

Academic & Skills

Spiritual

Ages 6-16 years

Parent/Guardian Information

Full Name *

Email Address *

Phone Number (WhatsApp) *

Street Address *

City *

Region *

Country *

Emergency Contact(Someone other than parent)

Contact Name *

Relationship *

Phone Number *

Children Information

Child 1

Full Name *

Date of Birth *

Gender *

School Name *

Grade Level *

T-Shirt Size *

For your child's Alpha Kids program t-shirt

Terms & Consent

By checking this box, I confirm that I have read, understood, and agree to all the terms and conditions stated above. I consent to providing my personal and my child(ren)'s information to PICParent for the Alpha Kids Mentorship Program. I agree that my child(ren) and I will adhere to all rules, regulations, requirements, and tasks of the program. I am the parent or legal guardian of the child(ren) being registered and have the authority to provide this consent on their behalf. *

Questions? Contact us