The Birthday Club Inc.

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Join the Birthday Club!

Everyone deserves to feel loved, valued, and celebrated on their birthday! Join The Birthday Club Inc. and discover a world of birthday wishes, thoughtful surprises, and meaningful celebrations that grow with you each year.

Who are you joining The Birthday Club for? * *MyselfMy child or someone in my careSomeone I would like to refer

Parent or Guardian InformationRequire parent or legal guardian authorization for minors.

Parent/guardian full name *

Parent/guardian email *

Parent/guardian phone number *

Additional Referral Questions

Your Relationship to the Individual *

Are you referring on behalf of an organization? *YesNo

Organization Name

Do you have permission to share this person's information? *YesNo

Has the individual or their legal guardian agreed to be contacted? *YesNo

First Name *

Last Name

Date of Birth *

Month

Day

Year

Participant Age Group

City *

State/Province *

ZIP / Postal code *

Contact Email *

Contact Phone

Preferred Contact MethodPhone CallText MessageEmail

Let's Get to Know Your Birthday Wishes!

Tell us a little about what makes your birthday special.

What type of birthday support interests you? *Birthday Card & SongBirthday GiftBirthday Care PackageBirthday CelebrationMonthly Birthday EventsNot Sure Yet

What are some of your favorite things? *

Is there a special birthday wish you'd like to share? *

Birthday Month/Day *

Month *

Day *

Year *

Favorite Activities or Hobbies *

Favorite Colors *

Birthday Gift Wish List

Favorite Colors *

Interested in Monthly Celebrations? *YesNo

Anything Else We Should Know?

What circumstances make birthday support meaningful for you or the person you're referring?

What would birthday support mean to you or the participant?

Is there anything we should consider to make the celebration comfortable and accessible?

Would you like information about community birthday events?YesNo

May our team contact you to discuss birthday support?YesNo

One Step Closer to Birthday Joy!

Thank you for your interest in The Birthday Club Inc.! Please review your information before submitting. Our team will review your registration and contact you or the authorized representative about program availability and next steps. Required Agreement I confirm that the information provided is accurate to the best of my knowledge. I confirm that I am authorized to submit this registration for myself, my child, or the individual being referred. I consent to The Birthday Club Inc. collecting and using this information to review the registration and contact the appropriate person.

Help Make
Birthdays Brighter!

Every gift, donation, and act of kindness helps create special birthday moments. Join us by giving, sponsoring, or spreading the word to bring joy to those in need.