Hunters Creek Elementary Kids Run the Nation Program 2015 Registration Form

Participant’s Full Name:  __________________________________________  Grade:  _______________________

Date of Birth:  __________________________

Parent/Guardian Name:  ________________________________________________________________________

Address:  _____________________________________________________________________________________

Telephone Number(s):  _________________________________________________________________________

E-mail Address:  _______________________________________________________________________________

Participant’s Emergency Contact Information (different from parent/guardian):

                                    Name:  ________________________________________________________________________

                                    Telephone Number(s):  ___________________________________________________________

Please list and fully discuss any known medical conditions:  ____________________________________________

_____________________________________________________________________________________________

Please list and fully discuss any known allergies – food, insect, medicines, etc.:  ___________________________

_____________________________________________________________________________________________

Does your child require/carry an EpiPen to use if an allergic reaction occurs?  ____________________________

Registration fee:  $30  to cover the cost of supplies, t-shirts, insurance, etc., for the 7-week program; or $5 per session (does not include t-shirt); Please make checks payable to “Kids Run the Nation”.  You also must submit a completed registration form regardless of whether you register online.  If you are a Woodview Elementary student, the fee will be waived, but a completed registration and liability waiver are required and a t-shirt is not included.

The 7-week program will commence on Sunday, March 1, 2015, and will end on April 26, 2015, excluding March 15 and April 5, 2015.  We will meet from 4:00 p.m. to 5:00 p.m. on Sunday afternoons at the Hunters Creek Elementary Track, 10650 Beinhorn, 77024.  Scan and e-mail the completed registration form to [email protected], or mail it to Anne Rappold, Kids Run the Nation, 7719 Brykerwoods Drive, Houston, TX  77055.  A REGISTRATION FORM, PAYMENT AND A LIABILITY WAIVER MUST BE RECEIVED BEFORE THE CHILD IS ALLOWED TO PARTICIPATE.