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Teen lounge

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Prom
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Home>
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Visiting Milwaukee campus>
Visiting Children's Wisconsin's Milwaukee Campus>
Social support for patients>
Teen lounge>
Prom>
Prom registration

2025 Patient Prom Registration

Patient first name

Patient last name

Patient age

Home address

Phone number

Please list diet restrictions/allergies

Do you use a wheelchair or have specific accommodations? Yes No

Please explain

Services (select all that you would like to receive) Hair Makeup

Parent attending/staying? Yes No

T-shirt size XS S M L XL XXL

Are you bringing a guest to prom? Yes No

Guest first name

Guest last name

Guest age

Guest address

Guest phone number

Please list guest diet restrictions/allergies

Does guest use a wheelchair or have specific accommodations? Yes No

Please explain

Services (select all that you would like to receive) Hair Makeup

Parent attending/staying? Yes No

Guest T-shirt size XS S M L XL XXL

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8915 W. Connell Ct.
P.O. Box 1997
Milwaukee, WI 53226
(414) 266-2000
(877) 266-8989 toll free
TTY: (414) 266-2465

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affiliated with the Medical College of Wisconsin.

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© 2025 Children's Wisconsin. Children’s Hospital and Health System, Inc. is a charitable, tax-exempt organization 501(c)(3) Tax ID: 39-1500074.
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