2012 Client Registration
To take advantage of any program at Howe Neighborhood Family Resource Center, you can simply fill out the "HNFRC Registration Form" for each person wishing to participate. This form only has to be submitted once per calendar year. After that, you can attend any program we offer without having to fill out MORE paperwork. Please take a moment and register you and your family members who wish to utilize the programs and services offered at HNFRC. If you have questions, please call 920.448.7340 and someone will gladly help you through the process.
Note: After you submit this form, you can click on the "Program Sign-Up" link in any program and sign up for individual programs.
Basic Information
First Name:
Last Name:
Street Address:
City:
Zip:
Phone:
E-Mail Address:
Date of Birth:
Gender:
Preferred Contact Method:
Emergency Information:
Emergency Contact:
Relationship:
Phone Number:
Alternative Phone:
Primary Physician:
Hospital Preference:
If Under 18:
Parent/Guardian Name:
Phone Number:
Allergies:
Medications:
Other Concerns (i.e. learning disability, medical condition, physical limitations):
Demographic Information:
Please complete the questions below with the answer that you feel most comfortable providing. We use this information to create, improve, and seek funding for programming. Please answer each question about the person being registered.
How many adults are currently living in your household?
How many children are currently living in your household?
How would you best describe your race/ethnicity?
What is your preferred language?
What is the highest level of education you have completed?
What was your annual household income last year?
What is your current marital status?
Which, if any, of these are currently affecting your family?
Does anyone currently living in your household currently attend Howe School?
How did you learn about the Howe Neighborhood Family Resource Center?
