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Kids Helping Kids Feedback Form

The Kids Helping Kids program celebrates and empowers kids, tweens and teens interested in helping patients and families at American Family Children's Hospital.

 

Please complete the form below to provide feedback about your Kids Helping Kids fundraising activities.

 

Photos

 

We love to share your photos with our staff and patients. Please send your photos via e-mail to kmalik@uwhealth.org or by mail to: Kylee Carolfi Malik, American Family Children's Hospital, Attn: K C Malik, 600 Highland Avenue, Madison, WI 53792-4165 

 

Contact Information

 
Organization
 
Schoot Type:
 
 High school
 Junior high school
 Elementary school
 Preschool
 Other
 
Age range of participating kids:
 
 Birth to 3 years old
 3 to 5 years old
 5 to 9 years old
 10 to 13 years old
 14 to 18 years old
 
Principal's Name
 
Organization Contact Name/Title
 
E-mail Address
 
Phone Number
Home  Work  Cell
 
Address
 

Fundraiser Information

 
Date and time
 
Campaign:
 
 Caps for the Cure
 Change Harvest
 A-Thon
 Be Brave, Go Bald 
 Peter Pan Birthday Party
 Other (please specify:  )
 
Why did you/your group do a fundraiser?
 
Who embraced the idea of a fundraiser?
 
 Student(s)
 Parent(s)
 Teacher(s)
 Principal
 Other (Specify:  )
 
 
How many students helped coordinate the effort?
 
Were the students part of a group?
 
 Student Council
 DECA
 FBLA
 NHS 
 Key Club
 Student volunteers
 Sports team (Specify:  )
 
What makes American Family Children's Hospital your charity of choice?
 
Have you done an American Family Children's Hospital fundraiser previously?
 
 Yes
 No
 

Gift Information

 
How much did your fundraiser raise?
 
Your contribution will support (please select one):
 
 Area of greatest need
 Patient and Family Fund
 Beat Childhood Cancer Fund
 Child Life Fund
 
Why did you choose to support this fund?
 
 

Follow Up Information

 
May we have permission to list your school on our Web site and other promotional pieces (e.g., annual reports)?
 
 Yes
 No 
 
Would you like an American Family Children's Hospital representative to attend an assembly at your school?
 
 Yes
 No 
 
If yes, please list your preferred date and time:
 
 
Would you a tour of American Family Children's Hospital?
 
 Yes
 No
 
If yes, please list your preferred date and time: