Key Leader Events

Attendee Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone (Mobile Number Preferred)*

Email*

Name of School (if Adult write "Chaperone")*

Year of Graduation

Please enter a number from 2019 to 2030.

Date of Birth*

Gender*

T-Shirt Size

Do you have any special needs (dietary or physical, etc) that we need to let the camp know about?

Demographic Information

How did you hear about Key Leader?*

Are you a member of?*

Builders Club
Key Club
None of the Above

Have you been to a Key Leader event before?*

Sponsoring Kiwanis Club*

If registering to be a Student Facilitator, please describe why you want to serve in this capacity?

Sponsor Information

Sponsor Name (in the case of chaperones repeat attendee information)*

First Last

Sponsor – is the person or organization that will provide FUNDING for your participation in the Key Leader weekend. (Example- Kiwanis Club, School, Parent)

Sponsor Phone*

Sponsor Email*

Emergency Information

Emergency Contact Name*

First Last

Emergency Contact Phone*

Relationship to Student (as an emergency contact)*

Registration

Attendee Type*

Student Participant
Key Club/Builders Club Participant
Key Club District Board Member Participant
Student Facilitator
Key Club District Board Member Student Facilitator
Adult Chaperones
Key Leader District Committee Chaperone

*Key Club District Board Member types require prior authorization from Key Club District Administrator. *Key Leader District Committee Chaperone option requires prior authorization from Key Leader District Chairperson.

Registration Cost

$0.00

Credit Card

Card Details

Cardholder Name

Kids Need Kiwanis

Attendee Information

Demographic Information

Sponsor Information

Emergency Information

Registration

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