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Blount Walks for Youth Team Registration
Register your team here! Teams are made up of 4 youth plus 1 adult team captain. If we get 100 participants, everyone will get a shirt!
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* Indicates required question
What's your team name? Be Creative!
*
Your answer
Location: School, Community, etc.
*
Your answer
How active are you and your team members? This is a rough estimate but will help us create activity level categories for a more balanced competition!
*
We walk/do physical activity that equals less than 5 miles a day per person
We walk/do physical activity that equals between 5 and 10 miles a day per person
We walk/do physical activity that equals more than 10 miles a day per person
Captain's Name and Email Address **Your team captain must be an
adult
who will submit your weekly reports** (List name under Team Member 1)
*
Your answer
Captain's Phone Number
Your answer
Captain's Demographics
Choose
Black
White
Hispanic
American Indian or Alaskan Native
Asian or Pacific Islander
Other
Captain
Choose
Male
Female
Prefer not to say
Captain's Age Range:
Choose
18-30
31-50
51-65
66+
Captain's Shirt Size
XS
S
M
L
XL
XXL
2X
3X
4x
Clear selection
Team Member 1 Name
*
Your answer
Team Member 1 Demographics
Choose
Black
White
Hispanic
American Indian or Alaskan Native
Asian or Pacific Islander
Other
Team Member 1
Choose
Male
Female
Prefer not to say
Team Member 1 Grade:
Choose
4-5
6-8
9
10-12
Team Member 1 Shirt Size
Youth XS
Youth S
Youth M
Youth L
S
M
L
XL
XXL
Clear selection
Team Member 2 Name
*
Your answer
Team Member 2 Demographics
Choose
Black
White
Hispanic
American Indian or Alaskan Native
Asian or Pacific Islander
Other
Team Member 2
Choose
Male
Female
Prefer not to say
Team Member 2 Grade:
Choose
4-5
6-8
9
10-12
Team Member 2 Shirt Size
Youth XS
Youth S
Youth M
Youth L
S
M
L
XL
XXL
Clear selection
Team Member 3 Name
*
Your answer
Team Member 3 Demographics
Choose
Black
White
Hispanic
American Indian or Alaskan Native
Asian or Pacific Islander
Other
Team Member 3
Choose
Male
Female
Prefer not to say
Team Member 3 Grade:
Choose
4-5
6-8
9
10-12
Team Member 3 Shirt Size
Youth XS
Youth S
Youth M
Youth L
S
M
L
XL
XXL
Clear selection
Team Member 4 Name
*
Your answer
Team Member 4 Demographics
Choose
Black
White
Hispanic
American Indian or Alaskan Native
Asian or Pacific Islander
Other
Team Member 4
Choose
Male
Female
Prefer not to say
Team Member 4 Grade:
Choose
4-5
6-8
9
10-12
Team Member 4 Shirt Size
Youth XS
Youth S
Youth M
Youth L
S
M
L
XL
XXL
Clear selection
I agree to accept full responsibility for any injuries I and my team may sustain while participating in this program. (Please initial) *
*
Your answer
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