Join Us

Join Maggie’s Kids Club

Want to become part of Maggie’s Kids Club? Have your parent/guardian sign you up and get a free book, a Maggie’s Kids Club member ID card and a Maggie sticker. (You must be 18 years or older to fill out this form.)

Get your very own Maggie’s Kids Club member ID card.

Child's Name *

Child's Age

Child's Birth Month *

Child's Birth Year *

Parent's First Name *

Parent's Last Name *

Phone

Address Line 1 *

Address Line 2

City *

State

Zip Code *

Are you a Magnolia Health member? Yes No

How did you learn about Maggie's Kids Club? Website Community Event Family/Friend Other

If you selected other, how did you hear about Maggie's Kids Club? *