Block Party Registration
Contact Information
Contact Information
First Name
*
Last Name
*
Age Group
<18
19-39
40-64
65+
Zip Code
*
Phone
Phone
Email Address
Block Party Information
Block Party Information
Did you register for the event in person or online?
*
In Person
Online
How did you hear about the Detroit Health Department's Block Party?
Detroit Health Department Staff
Family/Friends
News
Passing By
Radio
Social Media
Have you or will you receive services from the Detroit Health Department?
Yes
No
Why did you decide to attend the Detroit Health Department’s Block Party?
I was interested in the activities and entertainment.
I wanted to learn more about the Detroit Health Department.
Both
*
Send me a copy of my responses
Submit
Powered by
Privacy Policy
Report Abuse
This site is protected by reCAPTCHA and the Google
Privacy Policy
and
Terms of Service
apply.