Please enable JavaScript in your browser to complete this form.Parent's Information:Your Email *Your Name *FirstLastYour County *Select Your CountySelect Your CountyBrowardMiami-DadePalm BeachBroward CitySelect Your CitySelect Your CityCoconut CreekCooper CityCoral SpringsMiami-Dade CitySelect Your CitySelect Your CityAventuraBal HarbourBay Harbor IslandsPalm Beach CitySelect Your CitySelect Your CityAtlantisBelle GladeBoca RatonBroward Zip CodeSelect your 5 digit zip codeSelect your 5 digit zip code330043300833009Miami-Dade Zip CodeSelect your 5 digit zip codeSelect your 5 digit zip code330023301033012Palm Beach Zip CodeSelect your 5 digit zip codeSelect your 5 digit zip code334013340233403Your Child's Information:Children(S) You will bring *Select HereSelect Here12345You may add up to 5 children. 1st Child's Information Your Child's Name #1Child 1 BirthdayChild 1 GenderSelect HereSelect HereBoyGirlPrefer Not to Say 2nd Child's Information Your Child's Name #2Child 2 BirthdayChild 2 GenderSelect HereSelect HereBoyGirlPrefer Not to Say 3rd Child's Information Your Child's Name #3Child 3 BirthdayChild 3 GenderSelect HereSelect HereBoyGirlPrefer Not to Say 4th Child's Information Your Child's Name #4Child 4 BirthdayChild 4 GenderSelect HereSelect HereBoyGirlPrefer Not to Say 5th Child's Information Your Child's Name #5Child 5 BirthdayChild 5 GenderSelect HereSelect HereBoyGirlPrefer Not to Say TERMS & CONDITIONS *I agree with the Terms & Conditions: *Special offers and discounts will be sent to your email two months prior to your child’s birthday to help plan their celebration. On the date of their birthday, gifts from our sponsors will be emailed to you, redeemable for 30 days unless otherwise specified. Your free membership will automatically renew on an annual basis. Should you wish to cancel, email your request to info@familylifemediagroup.com. All offers and conditions are subject to change. By participating in our Birthday Club, your email address will be added to our Family Fun newsletter list. South Florida Family Life intends to send regular email updates and occasional promotional offers that may be of interest to you. You may opt-out of these mailings at any time upon receipt.Custom Captcha * 13 + 14 = Submit