Drug Free Kids Club Pledge Form

Please indicate whether you are a boy or a girl in the gender space below.

Please enter your date of birth in the space below in the following format - DD/MM/YYYY.

Please enter the first and last name of the person who invited you to be a member in the space below. If no one invited you, enter NONE.

Your parent or guardian must give permission for you to send this form. If they have agreed, please give their email address in the permission space below.

(Please enter the text in the image above. Text is not case sensitive.)
Click here if you cannot recognize the code.