Today's Date:

Member Name

Member Email:

Member DOB

Parent Name

Parent Email:

Parent Phone:

Your Address:

Your City:

Your State:

Your Zip:

Parents Signature: You must agree to the terms of this agreement - by checking "I Agree" I give my consent for my child to participate in activities provided by the Eco Hero Kids.

I agreeI do not agree


Child/Youth: $20
Individual Adult: $25
Family: $35
Friend – $10

After you send this form you will be redirected to payment page.