OnLine Membership Information

  

Kings Park Civic Association
Online Membership Information Form

Member Contact Information

Member Contact Information for KPCA Internal Records & Directory. Uncheck items you don't want listed in the directory
Information Field Member Contact Information List in Directory
Name:
Street (# and Name):
Phone Number:
Email Address:

Youth Jobs Listings in Directory (Optional)

Fill in a line for each youth in your household who wishes to advertise for certain jobs within the neighborhood. Check any applicable boxes for each youth, according to these codes:

BB = Babysitting HS = House Sitting OJ = Odd Jobs PC = Pet Care SS = Snow Shoveling YW = Yard Work
Name (one line for each youth) Age BB HS OJ PC SS YW

Volunteer Interests (Optional)

Check each area where you think you might be interested in volunteering. You are not signing up for anything here just yet. You are merely showing interest or willingness to help out. Please provide any Comments regarding any of your interests (particularly if you check the "Other" box). This information is NOT publicly listed.

Volunteering Interests Check All That Apply
Block Captain Neighborhood Watch
Emergency Preparedness Beautification and Landscape
Potluck Committee 4th of July Picnic/Parade
Social Committee Holiday Parties
Environmental Committee Recreation Committee
Other
Comments on Volunteering Interests:

Special Needs & Special Abilities (Optional)

Please list and describe any Special Needs or Special Abilities:

  • Examples of special needs.. need help with yard or housework, refrigeration for medicine in emergencies, among many others
  • Examples of special abilities... ability to help others with 4-wheel drive vehicle, generator, special tools, among many others

This information will not be publicly listed, but will be made available to block captains and board members.

Special Needs:
Special Abilities:
Registered With Fairfax County Special Needs Office

That's it! Please double-check your entries above, and when you are satisfied, hit the Submit Registration button below. Thank you for your interest!

Submit when complete