Please fill out this form to join Winegar's Kids Club
(stores located in Bountiful, Clearfield, and Roy, Utah),
an in-store activity program for children.
This form only acts as a sign up for the program and
is not tied to any other offers or promotions.

If you are 13 years old and younger, please get parental approval prior to submission of application.

*Required to become a member.

Select a Store: Not store specific Winegar`s Bountiful Winegar`s Clearfield Winegar`s Roy

Full Name:  *

Address:  *

City:  *  State:  *  Zip:  *

Gender:  *  Birthday (mm/yy):  *  Age:  *

Phone:  *

What is your favorite thing to eat? 

How many brothers & sisters do you have? 

Do you have a pet? 

What kind is it? 

What is its name? 

Your E-mail Address:  *

Comments or Questions: