SUPPORTING MILWAUKEE'S YOUTH
117 W Walker St #26, Milwaukee, WI 53204
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16th Street Registration Burnham Park
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16th Street Registration Burnham Park
Burnham Park Registration
35th & Burnham
Classes Start June 25th until August 30th
*Must have parent in 16th Street Clinic Walking Club to participate.
Advocate Information
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.
Advocate
Parent
First Name
Last Name
Email
Phone
Youths Information
First Name
*
Last Name
*
Age
*
Grade
Date of Birth
*
Parent Information
First Name
*
Last Name
*
Phone
*
Email
*
Please verify
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.
Yes
No
How did you hear about the program?
*
U.M.O.S
Journey House
16th Street Community Center
Facebook
Other
If other please let use know how?
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