16th Street Registration Burnham Park

Burnham Park Registration
35th & Burnham
Classes Start June 15th until August 3rd 6pm-7pm
*Must have parent in 16th Street Clinic Walking Club to participate.

Please let us know who is filling this form out? *
If you are an advocate please fill in your information. If you are the parent please continue to the next section on the child's info.AdvocateParent
First Name
Last Name
Email
Phone

I Verify that this child is 5 years old or older, but not 19 or over? *
Yes
Is a parent signed up for the 16th Clinic Walking Club? *
This City Champs class is designated to youth that has a participating parent in the 16th Street walking club only. Youth will only be allowed in if a parent is in the walking club.YesNo
How did you hear about the program? *
If other please let use know how?