Birthday Club

We are a nonprofit that is inclusive to all children with various backgrounds. We strive to make every child’s birthday a memorable one! We hope that you and your child join us by helping to make a child’s big day that much more special! Please fill out the form below to join the festivities!
Full Name (child/teen with autism)*

First NameLast Name
Birthday (child/teen with autism)*

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Social Media Handle:*
Do we have permission to use a birthday photo for use on our website?*

YesNo
Should be Empty: