PBS Western Reserve Adventure Club Registration Page

Thank you for registering with PBS Western Reserve Adventure Club!

Birthday information must be received at least two weeks prior to the week of the birthday.

Parent or Guardian's Information

First name *

Last name *

Country *

Street Address *

Street Address 2

City *

State *

Zip/Postal Code *

E-mail address *

Name of 1st child *

DOB of 1st child *

Month

Day

Year

Name of 2nd child

DOB of 2nd child

Month

Day

Year

Name of 3rd child

DOB of 3rd child

Month

Day

Year

Name of 4th child

DOB of 4th child

Month

Day

Year

Additional Children

Your gift is very much appreciated and may be tax deductible pursuant to IRC §170(c). A copy of our latest financial report may be obtained at pbswesternreserve.org.