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2026-2027 School Year

Please complete the information below to register for EPNC Teen Program. Our Neighborhood Center Director will reach out to you upon receiving completed forms. For questions, contact JWeber@wisconsinyouthcompany.org.

Within registration we use the term Parents. Families are varied and the use of the word Parent(s) refers to the adult(s) who are responsible for the child(ren).

Para ver esta página en español, por favor seleccione “Language” en la parte superior derecha de la página.

Elver Park Neighborhood Center Teen Registration

2026-2027 School Year

Step 1 of 3

33%

Participant Information

Participant's Full Name(Required)
Birthdate(Required)

Parent Information

Parent 1 Full Name(Required)
Parent 2 Full Name
Parent 1 Address(Required)
Parent 2 Address
Participant resides with:(Required)

Special Health Information

Medical Conditions(Required)
Allergies(Required)
Epi Pen(Required)
Behavioral or Emotional Needs(Required)
Asthma(Required)
Inhaler(Required)
Medications needed during program time(Required)

Emergency Contact

In addition to the primary and secondary persons listed above, list at least one emergency contact. Additional emergency contacts may be added as well.
Full Name Email or Home Address Phone # Relationship to child Emergency Contact Actions
         
There are no Entries.

Maximum number of entries reached.

I authorize my child to walk home from Elver Park Neighborhood Center (EPNC).(Required)
Registration and Permission to Participate(Required)
1. I am aware that if my child’s participation in any Elver Park Neighborhood Center program(s) for which they are registered requires more than reasonable accommodations, whether due to special needs or behavior, my child may be removed from the program.
2. I understand if my child has any special needs, I have so indicated in the special health information section of this form.
3. In the event my child becomes ill or injured, I understand that an effort will be made to reach me or an emergency contact person on file. I give consent for the Elver Park Neighborhood Center to act on my behalf to obtain emergency care and treatment if deemed necessary.
4. I am aware that my child may have the opportunity to participate in field trips. I give consent for my child to participate in field trips and be transported to and from any scheduled program activity for which transportation is required.
5. I understand that Wisconsin Youth Company may contact me via text messaging or email for the purpose of communicating reminders or urgent information that involves my child’s program. I understand that I can opt-out of this service by contacting the Wisconsin Youth Company administrative office.
6. I give permission for my child or me to appear in any media coverage approved by Wisconsin Youth Company Inc. and for Wisconsin Youth Company to use photos of my child in WYC publications, flyers, website, and social media.
MM slash DD slash YYYY
Parent/Guardian Name
Clear Signature

Demographic Information

Collected for grant purposes only.
My child's race is:(Required)
Check all that apply
My child's ethnicity is:(Required)
Is the head of your household male or female?(Required)

Community Feedback Request

Aside from youth programs, what types of programs interest you and your family?
Select all that apply
What types of events & services interest you and your family?
Select all that apply
Have you attended our annual Back2School Block Party?
What age groups are important to your family for future programs and services offered by our center?
Select all that apply
Please select any barriers that prevent you from participating in center programs or services.
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1201 McKenna Blvd.
Madison, Wisconsin 53719
Email: info@wisconsinyouthcompany.org
Phone: 608-276-9782
Fax: 262-547-0394
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Email: info@wisconsinyouthcompany.org
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