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Registration Page
MBJH - Magic Moments Club
Student / Parent Information ( denotes required field)
Parent(s) Name:
Student First Name:
Middle Name:
Last Name:
Student Id:
Address:
City: State: Zip Code:
Email Address:
Phone Number:
Notes:
Information
This donation is part of a fundraiser aimed at funding the Magic Moment for a local child suffering from a life altering illness. Once the fundraising goal of $4,000 has been met, we will be able to present the child with their special moment during a celebration event. As part of your donation, you are gladly invited to attend the presentation celebration event. Thank you in advance for your kind and generous donation for this worthy cause.
Fee Items
Payment
  Sub Total: $ 0.00
Convenience Fee: $ 0.00
Total Amount Due: $ 0.00
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