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100 Mile Club Registration Form
Please fill out the following form and submit to register for BLES 100 Mile Club. Please fill out one for each student registering. Registration ends SEPTEMBER 18TH!
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* Indicates required question
Parent Full Name:
*
Your answer
Contact information: phone number or email address
*
Your answer
Student Full Name:
*
Your answer
Student Grade Level:
*
TK
Kinder
1st
2nd
3rd
4th
5th
Student's Teacher
*
Mrs. Courtney
Mrs. Turney
Mrs. Szabo
Ms. Garland
Mrs. Begley
Ms. Hochee
Mrs. Hill
Ms. Mandolini
Ms. Rich
Mrs. Caughey
Mrs. Petteruto
Mr. Waner
Ms. Moore
Student Shirt Size
*
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult Small
Adult Medium
Other:
If you Choose "Other" above what size will you need:
Your answer
Payment Options - We will take cash or check. Checks payable to BLES. If mailing payment checks only please. You can drop off either at school during regular business hours. Shirts will not be ordered until payment is received.
*
Cash or check dropped off at school
Mailed in check
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