Social Distancing Distance Club (Chinle Area) Registration
For middle-school-aged youth (Grades 5-8) and their siblings living under the same roof in the Chinle IHS service unit. Please register middle-school-aged students using this form first. If there are more members of your family that would like to participate, use the link provided once you submit this form to register additional registrants. If you have questions, you can call (505) 977 5057 Thank you.
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Participant #1's First Name *
Participant #1's Last Name *
Age *
Grade *
Gender *
School They Attend *
Email Address (if they have one)
Phone Number (if they have one)
Preferred T-Shirt Size *
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