WinterKids 5th, 6th, and 7th Grade Passport Application

Are you ready for a whole winter of healthy outdoor fun?

Please complete this application for your WinterKids Passport.

Please type CAREFULLY and fill in all required fields.

Passport Options

Please note: Passports will be mailed beginning Nov. 1, 2010
$25 Standard Processing, 3-4 weeks delivery
$50 Rush Processing (includes $25 rush fee), 3-4 days delivery
no-cost scholarship, (Please call 871-5700 ext. 104, after submitting this form)

Payment Method

Check (mail to WinterKids, P.O. Box 7566, Portland, ME 04112)
PayPal or Credit Card

Personal Information

FIRST NAME:
MIDDLE NAME:
LAST NAME:
MAILING ADDRESS:
TOWN:
COUNTY:
STATE:	ME
ZIP CODE (5 Digit Only):
STUDENT BIRTH DATE:	/ /
PARENT'S FIRST NAME:
PARENT'S LAST NAME:
TELEPHONE NUMBER:	(207) -
GRADE:
SCHOOL NAME:
CURRENT GRADE TEACHER:
PARENTS EMAIL ADDRESS
PLEASE CONFIRM EMAIL

Parent or Guardian: you must type your full name in the box above.
By doing so, you are consenting to the Terms of the Agreement

Not Valid Unless Electronically Signed by Parent or Legal Guardian.

Passports will be mailed beginning November 1st.

Learn about our WinterKids Programs

Guide to Outdoor Active Learning

Active Academics Workshop

Passport Program

Welcome to Winter

* We understand that WinterKids will use our email address to send occasional emails to us, but will not sell or give our email address to anyone.