Coyote Kids Interest FormPlease note that this is not a registration form, filling out this form does not give you a spot in the program. The Coyote Kids Team will contact you if there are spots available. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name of Parent/Guardian/Caregiver *FirstLastAgency/or group home name? (If Applicable)Email *Phone *How many children would you like to register? *OneTwoThreeFourFiveSixAre the children/youth Indigenous? *YesNoPlease name the tribe/band name/community/or settlement they are from. *Are the children/youth in foster/kinship/or group home care? *YesNoChild's InformationChild's First Name *Child's Date of Birth (D/M/Y) *Child's Age *Gender *MaleFemaleOtherOther Gender (Please Specify)Child #2 InformationChild's First Name *Child's Date of Birth (D/M/Y) *Child's Age *Gender *MaleFemaleOtherOther Gender (Please Specify)Child #3 InformationChild's First Name *Child's Date of Birth (D/M/Y) *Child's Age *Gender *MaleFemaleOtherOther Gender (Please Specify)Child #4 InformationChild's First Name *Child's Date of Birth (D/M/Y) *Child's Age *Gender *MaleFemaleOtherOther Gender (Please Specify)Child #5 InformationChild's First Name *Child's Date of Birth (D/M/Y) *Child's Age *Gender *MaleFemaleOtherOther Gender (Please Specify)Child #6 InformationChild's First Name *Child's Age *Child's Date of Birth (D/M/Y) *Gender *MaleFemaleOtherOther Gender (Please Specify)How did you hear about Coyote Kids? *Online Search (Google, Bing, Yahoo, etc.)Bent Arrow WebsiteWord of MouthAdvertisement (Newspaper, Radio, Bilboard,etc.)Social Media (Facebook, Instagram, X (Twitter), LinkedIn, etc.)Bent Arrow's ReceptionBent Arrow StaffOtherOther *Submit
