Thank you for supporting Take 5 Wisconsin!

With the following information, we will work to match you with a family in your district.

Fields marked (*) are required

Full Name:

Address:

City:

Zip Code:

County of Residence:

Phone Number:

Email From:*

Again we thank you for your interest. A family will be calling you to arrange a visit that works well with your schedule. If you have any questions, please contact:

John Shaw
Shawj2@dhfs.state.wi.us
Phone: 608.266.7707

Fil Clissa
Clissfp@dhfs.state.wi.us
Phone: 608.266.5395