Journeys Kidz

Enrollment Form

Please allow at least 6-8 weeks from when we receive your registration form for your child(ren) to be enrolled and eligible to receive their birthday card.

Journeys Kidz Birthday Club is for children up through the age of 12.

Parent / Guardian Information


First Name *	Last Name *	MI	Title	Gen.

e-mail address *	confirm e-mail address *


Address Line 1 *	Apt / Floor / Room

Address Line 2

City*	State*	Zip*

Date of Birth (MM/DD/YYYY)*

Child #1


First Name *	Last Name *		MI	Gen.

Birthdate (mm/dd/yyyy) *	Boy*	Girl*

Child #2


First Name	Last Name		MI	Gen.

Birthdate (mm/dd/yyyy)	Boy	Girl

Child #3


First Name	Last Name		MI	Gen.

Birthdate (mm/dd/yyyy)	Boy	Girl

Child #4


First Name	Last Name		MI	Gen.

Birthdate (mm/dd/yyyy)	Boy	Girl

Child #5


First Name	Last Name		MI	Gen.

Birthdate (mm/dd/yyyy)	Boy	Girl

Digital Signature


First Name *	Last Name *	Date * (mm/dd/yyyy)

Yes! I would like to receive special discounts and offers by email.

Please send me a Journeys Kidz catalog by mail

By entering your name and pressing "SIGN ME UP!," you are signing this record and verifying to Journeys Kidz that you are (1) the parent or legal guardian of the child(ren) listed above, (2) 18 years of age or older; and (3) consenting to register the child(ren) listed above into the Journeys Kidz Birthday Club.