Contact information
Welcome to our Lifeguard Kids Club sign up! By filling out and submitting this form you are giving us permission to contact the child via mail for birthday surprises, email updates with a verse and an encouraging word, fun church activities or VBS programs that will come up. Thank YOU for letting Life 90.5 be apart of this child's life!
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Guardian's First Name *
Guardian's Last Name *
Guardian's Email *
Child's First and Last Name *
Child's Birthday *
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Child's First and Last Name (If you have more than 1 child signing up)
2nd Child's birthday
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YYYY
Child's First and Last Name (If you have more than 1 child signing up)
3rd Child's Birthday
MM
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DD
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YYYY
Mailing Address *
City *
State *
Zip Code *
Grade *
Phone Number
Child's Email
Child's Gender *
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