From the K Club

K Club Kids Registration Form

K Club Kids supports patient families. Share a little about your family and we will reach out.

Patient Information

Patient's First Name

Patient's Last Name

Patient's Birthday

Diagnosis

Diagnosis Date

T-Shirt Size

Is the patient currently receiving treatment?

YesNo

Is the patient treated, or were they treated, at Oklahoma Children's Hospital/Jimmy Everest Center?

YesNo

Parent(s) Information

First name

Last name

Other Parent (optional)

Address

Address 2 (optional)

City

State

ZIP

Cell Phone

2nd Phone (optional)

2nd Email (optional)

Siblings (names and ages) (optional)

Getting to Know Your Child

What does your child like to do for fun? (optional)

What are a few of your child's favorite things? (optional)

Please check here if your child would like to participate. (optional)

Art With A Heart is an annual art auction that raises funds for local childhood cancer organizations, including The K Club. Patients get to paint with a professional artist, and their art is auctioned off at a fun event for the whole family.

Sometimes we have opportunities for children to participate with OU or OSU sports. Is your child an OU or OSU fan? (optional)

Yes - OSUYes - OUYes - bothNo

Is there anything else you'd like us to know about your child? (optional)