Walking the Walk Philadelphia Network Application 2021-22

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Welcome! Thank you for your interest in applying for the Walking the Walk Youth Initiative.

This application will require you to gather some contact details from your parent(s) or guardian(s) as well as personal medical information.

If you need to save this application and return to it at a later time, please click the "Save my progress and resume later" link above, and enter your email address and a password when prompted. When you return to this form later, you will be able to continue your original application by clicking "Resume a previously saved form."

If you have any questions or issues with this form, please contact Elexus Freeman-Filmore at eff@interfaithphiladelphia.org or (215) 222-1012 x4.

Applications are due October 20, 2021.
Student Contact Details

Questions About You

Tell Us About Yourself! Please answer the prompts below in 1-5+ sentences. During your Walking the Walk experience you will be invited to…

Parent/Guardian Contact Information (main contact)

Parent/Guardian Contact Information (secondary contact)

If parent/guardian cannot be reached:

Medical information
If the student has any condition that might require medication, accommodation and/or special attention, please detail the condition and explain any measures that are needed to provide proper care.

Please download and review the following documents before completing this form.

* Release And Waiver Of Liability And Indemnity Agreement

Interfaith Philadelphia requires a hand-written signature for our release form. Please print and sign the "Release and Waiver of Liability and Indemnity Agreement." Download Waiver Form.

Program Fee


Interfaith Philadelphia
100 W. Oxford Street, Ste. E-1300
Philadelphia, PA 19122
Payment Information