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Sign-Up for FUN Club After-School Program

Sign-Up for FUN Club After-School Program
Parent Name*
First Name Last Name
Phone Number*
E-mail*
Child 1 Name*
First Name Last Name
Child 1 Birth Date*

Month Day Year
Current Grade (2025/26)*

Kindergarten1st2nd3rd4th5th6th
Child 1 School Attending*
Does your child have any allergies, special needs, or health conditions?*
Child 2 Name
First Name Last Name
Child 2 Birth Date

Month Day Year
Current Grade (2025/26)

Kindergarten1st2nd3rd4th5th6th
Child 2 School Attending
Does your child have any allergies, special needs, or health conditions?
Child 3 Name
First Name Last Name
Child 3 Birth Date

Month Day Year
Current Grade (2025/26)

Kindergarten1st2nd3rd4th5th6th
Child 3 School Attending
Does your child have any allergies, special needs, or health conditions?
In order for your child to be paired up with a designated Big Brother, we need a commitment of 3/4 weeks. Please select:*

I can commit to 3 out of 4 weeks per monthI can only commit for week-by-week
Your support makes this possible. Please consider partnering with us!

$100$180$360

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

I give permission to take photographs and / or video of my child. I grant full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the Fun Club's aims.
Digital Signature*
I would like to receive news and updates by email
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