Kids World

New Subscriber Registration

To register for the Kids-World system, please read the Kids-World agreement then complete the following form.

A Kids-World representative will contact you with an approval as soon as possible.

1. - Read the Kids-World Agreement.

2. - Accurately Complete the following form.

All fields marked with * are required.

Subscriber's First Name	*
Subscriber's Last Name	*
Subscriber's Address	*

City	*
State	*
Zip Code	*
Subscriber's Home Phone	*
Subscriber's Work Phone
Subscriber's E-Mail Address
Child Care Center Name	*
Center Street Address	*
Center City	*
Center State	*
Subscriber's Occupation
Mother's Maiden Name (for password identification)	*
Please provide us with a secret code word that can be used to access Kids-World. The word should be known only to Subscriber and Subscriber is solely responsible for maintaining the confidentiality of its password. In the event of unauthorized use of the password, Subscriber shall be liable for any losses, liabilities, costs and charges resulting therefrom. (One word only please) As a security precaution, the characters you type in the box below will be displayed as asterisks.
Secret Password	*
Confirm Password	*
Credit Card Information
We require your accurate credit card information for additional identification purposes. Please type carefully.
Credit Card	Visa * MasterCard * Discover Card *
Credit Card Number (no spaces please)	*
Expiration Date	Month * Year *
Name on Card	*
Your card will be billed a one-time $25.95 setup fee and a recurring monthly fee of $19.95. These fees may be waived during special promotions.
Billing Address (if different from above)
Address	*

City	*
State	*
Zip Code	*
Question / Comments
By submitting this form, you acknowledge that you have read and agree with the Kids-World contract and that the above information is accurate to the best of your knowledge.
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