PBS Kansas Kids Club

Kids Club membership $25 per child.

Please complete the following form. Fields marked * are required.

Thank you Gift

*Kids Club Membership

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Amount of pledge

Personal Details

*First Name

*Last Name

First Name 2

Last Name 2

*Street 1

*City

*State

*Zip Code

*Evening phone

Children's Names

By submitting this form, you give permission to use the child's first name, first initial of last name and birthdate on the on-air birthday greeting. You also give permission for photographs or videos of your child(ren) at Kids Club events to be used for PBS Kansas' Kids Club promotions.

*Names and DOB

If you don't want to give permission, please type OPTOUT after their names in the section above.

*Payment Method

Credit Card Check Bank draft or EFT

Electronic Funds Transfer

Bank Routing Number

Bank Account Number

Electronic signature

To confirm you have read our EFT Policy and agree to ongoing bank debits, please sign above in the format of /First Last/

Annual automatic renewal on credit card, debit card or EFT can help save you and the station time and postage. Would you be willing to sign up for automatic renewal on an annual basis? You may contact us to opt out at any time.

Annual Automatic Renewal

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Please select one.

Security

*Validation

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PBS Kansas Channel 8 Kids Club!

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