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Cooperative Extension Service	Agricultural Experiment Station
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Operation Military Kids (OMK)

Family Registration for Youth Participation

Adult Information

Name of adult completing this registration
Relationship to child / children being registered

Address

Mailing Address
City
State
Zip
Email
Area code and phone number

Military Branch

The children I am listing have a parent (or parents) in which branch of the military

To register your children for OMK programs, benefits and notifications, please provide the information requested below.

NOTE: This information will be maintained for confidential use by Operation Military Kids program leaders and staff, and will not be shared with others.

Name
Age on Jan. 1 of 2010
County

Would you like to register another child?

Yes
No

University of Arkansas • Division of Agriculture
Cooperative Extension Service
2301 South University Avenue
Little Rock, Arkansas 72204 • USA
Phone (501) 671-2000 • Fax (501) 671-2209

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