Lansing HEART

First Name

Last Name

Birthdate

Grade

Student Email/Username

Student Password

If Student Username and Password are both provided, child will have the ability to login.

Child Phone (Optional)

Enable Text Messages

Child is able and agrees to receive text messages at this number.
We understand carrier message and data rates may apply.

Medical Notes/Allergies? Yes No

Upload Child Photo (Optional) .jpg, .gif or .png

*	Please list any allergies or special concerns that we need to be aware of for this child. (other than seasonal)

Many Emails: Would you like to receive notifications IMMEDIATELY? Yes No

Delivery Type Whole Thread New Part Only

Daily Digest: Would you like to receive notifications ONCE A DAY? Yes No

Additional Questions

Payment Instructions

The yearly membership fee is $12.00 per family. All memberships will expire and be up for renewal each April.

Lansing HEART Clubs