Join Coast Kids!

Enroll A New Coast Kids Member

Quantity
Price
Total
Enroll One Child

Enter quantity "1" for this item to enroll at least one child in our Coast Kids program.

X
$
35.00=
$
0

Enroll Each Additional Child

To enroll more than one child in our Coast Kids program at a discounted rate, enter the total number of ADDITIONAL children as the quantity for this item.

X
$
20.00=
$
0

Final Total:
$
0

Coast Kids Member Names

Please enter the FIRST and LAST name for each child that you wish to enroll.

1st Child's Name*
2nd Child's Name
3rd Child's Name
4th Child's Name

Coast Kids Member Birthdays

Please enter the birthday for each child that you are enrolling in mm/dd/yyyy format.

1st Child's Birth Date*
2nd Child's Birth Date
3rd Child's Birth Date
4th Child's Birth Date

Coast Kids Member T-Shirt Sizes

Please select the apprioriate T-shirt size for each child that you are enrolling. 

Coast Kids Photo Permissions

If you would like to give permission for your child's photo to be used by Assateague Coastal Trust and Coast Kids in any of our media formats, please select the option "Yes" below for each child. Otherwise, you may select the option "No."

Where Shall We Send the New Member Welcome Package(s)?

Please use the fields provided below to enter each child's complete mailing address where their new member welcome package will be sent. If the child's mailing address is the same as the billing address assocaited with this transaction, you may leave the field blank.

1st Child's Mailing Address
2nd Child's Mailing Address
3rd Child's Mailing Address
4th Child's Mailing Address

Billing Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code

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