Wilkes Heart of a Champion Day is currently only offered to Atrium Health Wake Forest Baptist partner high schools. Students that aren't at one of the following schools in the dropdown, will not be able to attend.
Students are required to complete full registration with Parent or Guardian present.
 *Please take the time, read through the questions, and answer to the best of your knowledge*
* = Required Information
This form is for the 2024-25 School Year
*Have you ever participated in Heart of a Champion Day before?   If Yes, what years?    
*Please select event timeslot:     Time slots can not be changed after registration is submitted
 
Personal Emergency Contact Information
*School Attending Next Year:   *Grade Entering:  
*First Name:   Middle Initial: *Last Name:  
*Street Address:   Apt/Unit: *City:  
*State:   *Zip:      
*Phone#:   *DOB:   *Age:  
Race: *Gender assigned at birth:       
*Email:    
Email will be used for further instructions
     
         

Parent/Guardian Information
* Parent(s)/ Legal Guardian(s) Residing With:   * Who Has Custody:  
* Fathers Name:   * Alternate Phone (Work/Cell):  
* Mothers Name:   * Alternate Phone (Work/Cell):  
Family Physician/Pediatrician: Physician Phone:
*Preferred Hospital:   *Permission To Transport To Hospital:  
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