SBS Winter Running Club

"*" indicates required fields

When: Thursdays, January 8-March 12
TIME: 3:00pm-4:45pm
GRADES: 1st-5th Grade
Cost: $15
Contact: Mr. Adam Cole, adam.cole@stonebridgeschool.com

PARTICIPANT INFORMATION

Participant #1 Name*

First Last

Participant #1 Grade Level*

Lower School (1st Grade)

Lower School (2nd Grade)

Lower School (3rd Grade)

Lower School (4th Grade)

Lower School (5th Grade)

Participant #1 Date of Birth*

Participant #1 Sex*

Male

Female

List of allergies or medical conditions for Participant #1, if applicable

PARENT INFORMATION

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone #1*

Phone #2

Email*

Emergency Contact (Alternative)

Name*

First Last

Email*

Address

Street Address City State / Province / Region ZIP / Postal Code

Accident/Injury Release Agreement

Payment Option*

Bill me in FACTS (SBS students ONLY)