Official Membership Enrollment

Complete this form to join the Family Room. We'll follow up to confirm your details and review all your member benefits.

Your Family Membership Name *

Your First Name *

Your Last Name *

Your Email *

Your Phone *

Your relationship to child(ren) *

Birthdate (for gifts, treats, and caregiver activity programming)

Address 1 *

Address 2

City *

State/Province *

Postal Code *

Caregiver 2 Name

Caregiver 2 Email

Caregiver 2 Relationship to child(ren)

Caregiver 3 Name

Caregiver 3 Email

Caregiver 3 Relationship to child(ren)

Child 1 Name *

Child 1 DOB (for accurate activity aging) *

Child 2 Name

Child 2 DOB (for accurate activity aging)

Child 3 Name

Child 3 DOB (for accurate activity aging)

Child 4 Name

Child 4 DOB (for accurate activity aging)

Please verify your request. *

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