Sign Up Application for Kidz Can, Inc.The application for Kidz Can, Inc. welcomes each trusted adult of a youth who has experienced domestic violence to apply. They will have a chance to enter our program where we support you with life coaching skills, help pay for activities like the zoo, and many other locations. Once this form is filled out and reviewed; you will receive a response through email or a phone call. We can only accept a specific amount of youth at a time and at times there may be a wait list for some parts of the program. There is always help and resources available for you!Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Contact Number *How did you hear about Kidz Can, Inc.?Can you share with us a brief explanation of what is going on and what help you may have already been receiving? The information shared here is confidential and for us to better help you. *Comment or MessageSubmit