Get Moving Breckinridge County Registration Form Spring 2019

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Get Moving Breckinridge County is a program to encourage physical activity hosted by the Breckinridge County Extension Service, Ben Johnson Elementary School, the Breckinridge County Public Library, and several community agencies focused on community health and wellness. The Program will run six weeks from May 20th to June 30th. Each week will run from Monday to Sunday and you will log your steps each Monday from the previous week. May 27th will be the first Monday that you log steps on a shared google sheets document that will be shared with you through email after you register. With this collaboration, the Breckinridge County Public Library will offer a free 5K on June 29th.
Lets get healthy and lets GET MOVING BRECKINRIDGE COUNTY!!!

Last Name *

First Name *

Mailing Address (street or PO Box) *

City *

Zip Code *

Phone Number *

Email address *

If completing the program as a team, what is the name of your group?

Please select your gender

Male

Female

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What is your age?

Younger than 18

18-24

25-34

35-44

45-54

55-64

65-74

75 or older

Clear selection

What race do you most identify with?

Caucasian

African American

Asian/Pacific Islander

American Indian or Alaska Native

Hispanic

Other

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