Please fill out the following form to become a VIP Club Member! To have your child's picture posted in our online “Club House,” please click here to email the picture, then fill out the Birthday Club Registration Form below.
If you prefer, you can mail a picture to Nathaniel's Hope, 2300 Jetport Drive, Orlando, FL 32809-7800. Please include a note to tell us your child's name, birthdate, that this is for the VIP Birthday Club, and whether or not you would like the picture back. If we can keep the picture, we'll add it to the collection of pictures posted in our office!
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| * indicates required fields |
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| Adult's First Name: |
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| Adult's Last Name: |
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| Child's First Name * Required |
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| Child's Last Name * Required |
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| Address: |
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| City: |
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| State: |
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| Zip/Postal Code: |
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| Country: |
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| County (not CountRy): |
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| Home Phone: |
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| Cell Phone: |
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| Work Phone: |
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| Email: |
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| How did you hear about Nathaniel's Hope? |
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| Child’s Birthday (mm/dd/yy) * Required |
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| Please explain your child’s special needs: |
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| Child’s School: |
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| Child’s Gender: |
Male Female |
| Special Equipment used (wheelchair, walker, etc.): |
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| Child’s Special Talents/Abilities: |
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| Would you like for your child’s information to be included in the online VIP Birthday Club? (This is not required to be a member of the VIP Birthday Club.) |
Yes No |
| Please indicate your preference regarding the online portion of the VIP Birthday Club: |
Name on Web
First name only on Web
DON’T list name on Web |
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Picture on Web (click here to email the picture)
DON’T put picture on Web |
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