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Cover Kids Entry Form

Cover Kids Entry
Please print the following form then mail it with a photo and a $25 check to: Cover Kids, Carolina Parent, 5716 Fayetteville Rd., Suite 201, Durham, NC 27713. *DO NOT SUBMIT THIS FORM ONLINE. WE MUST RECEIVE A HARD COPY WITH YOUR CHILD'S PHOTO. Questions? Call (919) 956-2430.

This form is not complete.

 
Entry Information
* child's name
* child's date of birth
* parent's name(s)
* address
* city
* state
* zip
* phone
parent's email
* signature of parent/legal guardian for photo release
Credit Card Payment Info
Please disregard this section if you are paying by check.
type of credit card
VISA
MC
AMEX
DISCOVER
name on card
card number
exp date

 
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