Bing Bang Rally Gang presented by Sweet Basil Pizza
FREE Membership Sign-Up

Parent/Guardian Information

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* 1. Please enter your first & last name.

First Name

Last Name

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* 2. Please enter your physical address, including city and zip code.

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* 3. Primary Email Address (one you will check - we will email you from time to time with information about the Rally Gang - we will not sell your email):

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* 4. Home Phone Number

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* 5. Cell Phone (s) (edit your mobile number to get exclusive deals on game-nights - msg & data rates may apply. Expect 1-2 text msgs per week)

Cell Phone (primary)

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* 6. Your child's name first & last name:

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* 7. Child's Birthdate:

Birthday:

Date

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* 8. Do you have more than one child you are signing up (maximum of 4 children)?

Yes

No

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* 9. If "Yes" - how many? (maximum of 4 kids per household)

1

2

3

4

Please list their names and birthdates:

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* 10. How did you learn about Bing Bang Rally Gang?