Register Your Youth Champion Event

Register Your Youth Champion Event

Please complete the below registration form. If you have questions, contact  Mary Derr or call (614) 355-5432. Allow 2 to 4 weeks for approval.

Youth Champion Event Registration Form
Contact Name: *
Youth Champion Name: (if different from above)
Are you a:
School Administrator
Teacher
Student
Parent
Other
School and/or Oganization Name: (if applicable)
Address 1:
Address 2:
City:
State:
Zip:
Phone: *
Email:
What kind of fundraiser are you planning? (Check all that apply)
Sale (Bake sale, flower sale, lemonade stand, etc.)
Drive (Toy Drive, book drive, etc.)
Athlete Challenge (Dance-a-thon, 5k, etc.)
Change for Children (Penny wars, collecting coins, etc.)
School Spirit (Jeans day, school dance, talent show, spirit week, etc.)
Benefitting Event (Banquet, carnival, vendor event, etc.)
Other
Event Name:
Where will your event be held?
When will your event be held?
Please describe your event:
Additional comments:

Questions?

Contact Mary Derr at (614) 355-5432 if you have questions or would like additional information.

Youth Champions Contact Information

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000