2022 Milwaukee Fatherhood Summit - Event Registration Form

First Name: 

Last Name: 

Date of Birth:   MM/DD/YYYY

Cell Phone: 

Address: 

Zip Code: 

Email: 

Are you Facebook friends with Milwaukee Fatherhood Initiative?   Yes     No

Wll this be your first time attending the Milwaukee Fatherhood Summit?   Yes     No

If No: How many summits have you attended previously? 

Are you interested in learning more about a research study to support fatherhood classes?  Yes    No

What is your age? 

What is your gender?  MaleFemalePrefer Not to Answer

What is your ethnicity?  African AmericanHispanic LatinoCaucasian/WhiteOther

How many children do you have?  None1-23-5More than 5

Are you employed?   Yes     No

How did you hear about the Summit?  Family or FriendsService Agency (New Concept, DCD, UMOS, etc.)Advertising (radio, TV, newspaper)Other

Educational Level: 

 No Graduation 

 High School 

 Some College

 Associate/Bachelor's Degree 

 Master's Degree

 Doc. or Prof. Degree

While at the Summit I am interested in ( check all that apply)

Child Development

Child Support Services

Community Advocacy/Outreach 

Credit Repair

Drivers License Recovery 

Employment

Expungement/Pardon Services

Family Resources

Health Screening (at event)

Immunization (flu or COVID-19 or booster available - each person vaccinated will receive $25 gift card while supply lasts)

Stress Reduction or Mental Health Support

I plan to bring a child/student under 12 years old (sign us up for face painting, games, and other family friendly activities).

How many children will be attending with you? 

Thank you for registering to join us this year! 
 

Milwuakee Fatherhood Summit