Please use this form for reservation requests that are at least 24 business hours in advance. If your need is urgent, please TEXT YOUR REQUEST to (608) 719-4024. Request A Reservation Parent's Full Name(Required) Email(Required) Phone(Required)Child(ren) Name(s)(Required)Please list each child on a separate lineChild(ren)'s Date of Birth(Required)Please list each birthdate on a separate lineDate of Requested Reservation(Required) MM slash DD slash YYYY Reservation Time (Beginning)(Required) Hours : Minutes AM PM AM/PM Reservation Time (Ending)(Required) Hours : Minutes AM PM AM/PM Will you be using any outside funding for this reservation?(Required) Yes No Are you affiliated with University of Wisconsin-Madison?(Required)It is not required that you have a UW Madison affiliation to use the Center. Not Affiliated UW-Madison student UW-Madison University Staff Choice UW-Madison Academic Staff UW-Madison Faculty UW-Madison Fellow/Scholar/Post-Doc UW-Hospital and Clinics If you have a UW Madison affiliation, please enter your department.Ask about our School of Medicine and Public Health discount. Does your child have any special needs or allergies we should be aware of?(Required) Yes No If you answered yes, please list below.Consent(Required) I have read and understand the Little Chicks policy and procedures.
