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2020 Spring YMIM Registration
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shp1vp@gmail.com
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* Indicates required question
Email
*
Your email
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student Grade in 2019-2020
*
Choose
3rd
4th
5th
6th
Teacher's Name
*
Your answer
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Phone Number Type
*
Home
Work
Cell
If Cell number, can you receive text messages?
Yes
No
Clear selection
Emergency contact name and phone number (during class)
*
Your answer
List any health or other concerns here.
Your answer
Select t-shirt size
*
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult X
Participation Consent
*
I give permission for my son to participatein this program and understand the physical risks with running and completing a5K race. I am aware that I will need to make sure he is dropped off at the frontof the building at 8:00 am.
I do not give permission for my son to participate in this program.
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