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Girl climbing rope

Membership Form

JOIN THE CLUB Fill out the form below and start making an impact on children's lives!

Full Name: 

Name of Company:

Mailing Address:

Contact Person:

Phone:

Contact Email:

Type of Vehicle:

Space Needed (length & width, ft) 

How is the vehicle normally used?

Lead adult who will be attending the vehicle on the day of the event:

Hold Harmless Agreement: Vehicle owner agrees that it will indemnify and hold harmless Kiwanis International and the Kiwanis Club of Kernersville, a Kiwanis club, from and against all losses, claims, suits or other legal liability and legal expenses of any nature imposed upon or brought against them by reason of any act or omission of the contractor/service provider or its agent or employees in the course of performing the work of providing the services that are the subject of this contract.

Cost to Participate: Free.

We welcome contributions to be used towards event advertising and event proceeds to benefit children’s programs sponsored by the Kiwanis Club of Kernersville. See below for various sponsorship opportunities.

Sponsorship Opportunities:

Select an option

Mail your contribution and application to:
Leigh Cannon
John Deere, PO Box 1187, Kernersville, NC 27285-1187.
Email: leighsspace@gmail.com

Thanks for submitting!

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