Running Club  *  Grades K - 5   *   FALL 2022
* Wednesdays, Sept. 21 - Nov. 30; 3:00-4:00pm   
* Club fee: $20/student or $30/family (All money needs to be given to Coach King. Checks made payable to Jefferson Elementary School. Please put the money in an envelope with "Coach King / Cycling Club" written on the envelope. You may turn this in to your student's teacher and they will get it to me.)
* Race fee: Race registration is done separately by you. More information on this soon.
* Limited participants: We are limited to 30 participants unless we have parent volunteers. 
* You will pick up your child at the front of the school at 4:00pm. Please be on time as our teachers/volunteers have other commitments in the evenings.
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Email *
Permission Slip & Emergency Medical Information
Name of Participant
Participant’s Teacher & Grade
Participant’s Parent(s)/Guardian(s)
Address, City, Zip Code
Cell Phone Number
Email Address
Participant's FIRST emergency contact Name, Phone Number, Relationship
Participant's SECOND emergency contact Name, Phone Number, Relationship
Does the participant have any medical, physical, or any other condition of which we should be aware?
Does the participant have any allergies?  Food allergies?
Are there any specific procedures, mediations, etc. that our staff should be alerted to?  If so, please specify in detail in the space below. 
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