Youth Advisory Council Application

Patient and Family Guide

Youth Advisory Council Application

American Family Children's Hospital has a Youth  Advisory Council for children and teens who have been or are currently patients.
 
To apply, complete and submit the form below. We will follow up with you once we receive your application.
 
 
Application Information 
First and Last Name
 
Address
 
City, State and ZIP
 
Phone Number
 
E-mail Address
 
Parent/Guardian Information
 
American Family Children's Hospital will contact all applicants' parents/guardians prior to welcoming any child to either advisory board. Please enter the phone number and e-mail address of the applicant's parent/guardian below.
 
Phone Number
 
E-mail Address