2022 Milwaukee Fatherhood Summit - Event Registration Form

Father Son Hugging

Milwaukee Health Department Coronavirus COVID-19 updates. For assistance, please call the MHD COVID Hotline 414-286-6800

Event Date: Saturday, November 12, 2022

  • The Milwaukee Fatherhood Summit will be held at Destiny Youth Plaza, 7220 N. 76th Street, Milwaukee, WI.
  • Please stop at the lobby registration table for masks and to complete required registration or survey forms. 
  • The links to the virtual sessions will be posted on the main page at milwaukee.gov/fatherhood 

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? 

What is your ethnicity? 

How many children do you have? 

Are you employed?   Yes     No

How did you hear about the Summit? 

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? 

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