Pact, An Adoption Alliance - Program Descriptions

Teen Club

Pact Teen Club Program Registration

Pact underwrites and supports the Teen Club by requiring that all participants be members of Pact in good standing. If you are not already a current member you will need to join. After completing this form you will be directed to our online store where you can do this.

Teen Program Yearly Dues
Sliding scale - $75.00 - 150.00

Filling out this page does not mean you are officially registered for teen club!
After submitting this form you will be directed to our store where you will register and pay.

(Please fill out a separate form for each Teen or Tween even if they are siblings.)

Teen or Tween Name:

Email Address:

Mailing Address:

City, State, Zip:

Home Phone:

Cell Phone:

Screen Name:

Birth Date:

Grade in Fall 2008:

Gender: Male Female

Race/Ethnicity:

Parent's Name(s):

Mailing Address:
(if different from child)

City, State, Zip:
(if different from child)

Home Phone:
(if different from child)

Cell Phone:

Email Address:
(if different from child)

Sibling Name & Birth Date

Sibling Name & Birth Date

Sibling Name & Birth Date

Current Pact Family Member? Yes No

Please list any issues, concerns or ask any questions you may have here:

Filling out this page does not mean you are officially registered for teen club!
After submitting this form you will be directed to our store where you will register and pay.

Teen or Tween Name:
Email Address:
Mailing Address:
City, State, Zip:
Home Phone:
Cell Phone:
Screen Name:
Birth Date:
Grade in Fall 2008:
Gender:	Male Female
Race/Ethnicity:

Parent's Name(s):
Mailing Address: (if different from child)
City, State, Zip: (if different from child)
Home Phone: (if different from child)
Cell Phone:
Email Address: (if different from child)
Sibling Name & Birth Date
Sibling Name & Birth Date
Sibling Name & Birth Date
Current Pact Family Member?	Yes No

Please list any issues, concerns or ask any questions you may have here: