Coyote Kids Interest FormPlease 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
