JOY Kidz Club

Child's Name (first & last)

Child's Date of Birth

Child's Grade Completed

Parent/Guardian Name

Complete Address (Street #, Street Name, Town, Postal Code)

Home Phone

Work Phone

Email address

Child's Allergies/Medical Information (optional)

Emergency Contact Name

Emergency Phone

Home Church

Do you consent to photos of your child being used in social media posts? (Yes / No)
YesNo