Enroll a Little

Child Enrollment Form

We are enrolling boys and girls, ages 6-12, in Milwaukee and Waukesha counties.

*Indicates required field

	*Parent or Guardian First Name
	*Parent or Guardian Last Name
	*Address Line 1
	Address Line 2, Example: Apt, Suite
	*Zip Code
	*Phone
	*Phone Type Home Work Mobile
	*Email Note: If you do not have email, put "No Email" in this field.
	*Child's First Name
	*Child's Last Name
	*Child's Birth Month
	*Child's Birth Day
	*Child's Birth Year
	*Child's Gender Male Female
	*Child's Ethnicity
	*Name of Child's School
	*Child's Grade Level
	*Does child have a parent incarcerated in a state or federal prison?: No Yes
	*Why would you like this child to have a Big Brother or Big Sister?: