Junior Optimist Application Form | Farmington - Farmington Hills Optimist Club

Junior Optimist Club Application

Student Information

Student Name(Required)

First Last

Birth Date(Required)

Age(Required)

Grade Level(Required)

School Name(Required)

T-Shirt Size

Student Phone

Parent/Guardian Information

Parent/Guardian Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Parent/Guardian Email(Required)

Parent/Guardian Phone(Required)

Media Release Consent

I hereby grant permission for the Farmington Hills Junior Optimist Club to take photographs and/or video recordings of my child, during Farmington Hills Junior Optimist Club activities and events. I understand that these images may be used for public relations purposes by Farmington Hills Junior Optimist Club, including but not limited to print and digital media, without compensation to my child or me.

I agree to the media release policy.

Junior Optimist Club Dues

Junior Optimist Club dues are $20. Dues can be paid in person with cash or check, but the preferred method is to pay online using a credit card. Checkout is secure through Stripe processing.

Junior Optimist Membership Dues

Price:

Payment Method

Pay now using credit card

Pay later with cash or check

Credit Card(Required)

Card Details

Cardholder Name

Name

This field is for validation purposes and should be left unchanged.