Galaxy Kid's Club

Please print out this application form to sign-up for the Galaxy Kids Club and take it to your nearest participating store.

Galaxy Kids Club Application

First Name:_______________________________________

Last Name:_______________________________________

Your BirthDay: Month_________ Day_____ Year__________

Your Email Address:________________________________

Your Home Address:

Street:___________________________

City: ____________________________

State:____________ Zip Code:________

Phone (____) _____________________

For Store Use Only: (To be completed by a Store Associate)

Store Number: ___________________________________

Kids Club ID Number:# _____________________________

Attention Parents: Your child’s information is confidential and will not be sold or shared with any entity outside of the Galaxy Kids Club. Any correspondence or special offers from our Galaxy Kids Club manufacturing partners will be processed through Merchants Distributors, Inc., parent company for the Galaxy Kids Club, in order to maintain your family’s privacy.