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I am a New Zealand Heart Child
I already belong to Zipper Kidz
My name
is
My address
is
My phone number is
My email address is
My Parents or Guardians are
My Brothers & Sisters names are
My Heart Condition is
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Zipper
Kidz is an exclusive club open only to New Zealand Children who are
aged between 0 and 20 years, who have a heart condition.
Shortly
after this form is received by Heart Children, you will be e mailed
details of your password, so you can enter our exclusive site.
(This may take upto 3 days)
Children please ask
your
Parents first
* Due to
membership being free, we have asked a multitude of questions to confirm
your validity as a heart child. This information will not be used
by any persons outside "Heart Children NZ Inc".
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