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Instructions for a parent or guardian Please print this form out, complete it and fax it to the number specified (if present) or mail to the mailing address below. Mailing Address: Kevin Muller 404 Cambria Ct Cranberry Township, PA 16066 |
| Choose a Member Name Member names must be between 3 and 32 characters long. |
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| Choose a Password Passwords must be between 3 and 32 characters long. |
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| Your email address You will need to enter a real email address. |
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Please sign the form below and send to us. I understand that the information that the child has supplied is correct. I understand that the profile information may be changed by entering a password and I understand that I may ask for this registration profile to be removed. |
| Parent / Legal Guardian FULL name | |
| Relation to child | |
| Signature | |
| Email Address | |
| Phone Number | |
| Date |