Healthy Family Challenge Submission Form

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Thank you for participating in the Mission: Healthy Kids 2021 Summer Healthy Family "How-to" Challenge. Mission: Healthy Kids is a partnership of Children's Wisconsin and Kohl's.

This is the final step in the Challenge, and you have either posted/submitted your video or will do so after completing this form. Please complete this form to confirm your video submission and choose which prize package* you would like to receive if you are selected in our random drawing. The deadline is August 6, and the random drawing for one of 10 family prize packages will take place the week of August 8, 2021.

If you have any questions, please email us at missionhealthykids@gmail.com.

*Children’s Wisconsin employees, their family members, and non-Wisconsin residents are not eligible to win prizes. Instead, Children's Wisconsin employees can earn 75 Healthy Rewards points.

Family contact person name - first and last (must be 18 or older) *

Home street address *

City *

County *

State (Only Wisconsin residents are eligible to be entered into the drawing to win family prize packages.) *

Zip code *

Primary phone number *

Primary email address *

Method of Submission *

Tik Tok

Facebook

Tik Tok Username (Your @name)

Facebook Username (Your @name)

Video topic area *

Nutrition

Physical activity

Mindfulness

Required

Select your prize (Ten families will win one of these prize packages through random drawing.) *

Staying In Bundle (Netflix gift card, DoorDash gift card, heated blanket, Amazon Firestick)

Going Out Bundle (Wisconsin Dells gift card, gas gift card)

Getting Active Bundle (four Fitbit Ace 2 Smartwatches, 6 month subscription to BeachBody on demand)

Eating Right Bundle (HomeChef Subscription, Children's Tumbler, Children's and Kohl's cooler)

Someone in my household is a Children's employee

I don't live in Wisconsin

Submit

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