Junior Optimist Club Application Student InformationStudent Name(Required) First Last Birth Date(Required) MM slash DD slash YYYY Age(Required)5678910111213141516171819Grade Level(Required)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeSchool Name(Required)Beechview Elementary SchoolEast Middle SchoolFarmington High SchoolFarmington Central High SchoolFarmington STEAM Academy 3-5Farmington STEAM Academy 6-8Forest Elementary SchoolGill Elementary SchoolHillside Elementary SchoolKenbrook Elementary SchoolLanigan Elementary SchoolLongacre Elementary SchoolNorth Farmington High SchoolMaria Montessori CenterPower Middle SchoolWarner Middle SchoolWood Creek Elementary SchoolT-Shirt Size(Required)Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XLStudent PhoneGill Elementary School Junior Optimist Club has met its capacity. Beechview Elementary School Junior Optimist Club has met its capacity.Parent/Guardian InformationParent/Guardian Name(Required) First Last Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Parent/Guardian Email(Required) Parent/Guardian Phone(Required)Media Release ConsentI 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 DuesJunior 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 EmailThis field is for validation purposes and should be left unchanged.
