Welcome!

Fill out the form below to get your confirmation code and join the fun.

Ticket Type

First Name *

Last Name *

Email *

Phone (optional)

Zip Code *

Adults attending

18 and older

Children attending

Under 18

Interested in free services? (optional)

✂️ Free Haircut

🩺 Free Physical / Health Screening

Special needs or accommodations needed?

Sensory, mobility, allergies, etc.

Dietary restrictions / food allergies (optional)

Optional — helps us report our impact to funders

Race / Ethnicity (select all that apply)

Health insurance (select all that apply)

Illinois Medicaid

Missouri Medicaid (MO HealthNet)

Other Insurance

📸 Photo & data consent

We may photograph this event and use anonymized attendance data in reports to sponsors and grant funders.