Lick's Homeburgers & Ice Cream

Join The Lick's Kids' Club!
Sign up to become one of the Lick's Kids' Club Members for all kinds of cool stuff! There will be great contests and specials for all the members and one lucky Kid's Club Member will win a cool prize every month! Fill out the entry form below to sign up for the Lick's Kids' Club.
Club is for Children 12 and under only.

Fill in this form to become a member of the Lick's Kids' Club!

Club is for Children 12 and under only.
To join please fill out the form below and press submit.

* required information
You must have your parent/guardian's permission to enter this ballot.
Check for "YES, I have permission" *

First Name: *

Last Name: *

Address: *

City: *

Province: *

Postal Code: *

Phone Number: * (xxx-xxx-xxxx)

Email Address: *
Your Age: *
Birthdate: (month,day, year)

How often have you been to Lick's in the past month?
Never Occasionally (1-3 times) Frequently (4+ times) *

Are there any products you would like to see on our menu?

Which store(s)_ does your family frequent the most?
Please list all that apply

Press submit to complete the form.

All information collected will be kept confidential for the expressed use of Lick's Concepts Inc. Prizes must be accepted as awarded. No Cash Value.