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Richmond Powder Run Registration 2016
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* Indicates required question
Parent Name (first and last)
*
Your answer
To ensure that you get a T-Shirt, please register by Friday, May 13th
Student Name/Adult Name (first and last)
*
Your answer
T-Shirt Size
*
YSmall
YMedium
XLarge
ASmall
AMedium
ALarage
AXL
Student Name/Adult Name (first and last)
Additional Child
Your answer
T-Shirt Size
YSmall
YMedium
XLarge
ASmall
AMedium
ALarage
AXL
Clear selection
Student Name/Adult Name (first and last)
Additional Child
Your answer
T-Shirt Size
YSmall
YMedium
XLarge
ASmall
AMedium
ALarage
AXL
Clear selection
Parent Contact Info (Cell Phone)
*
Your answer
Email
*
Your answer
Emergency Contact Info (name, number, and relationship)
*
Your answer
Number of kids attending
*
$20 per student. (if you need a scholarship email
diane.kane@cesuvt.org
)
1
2
3
Other information (Allergies, etc.)
Your answer
Volunteering for the Richmond Powder Run
*
Are you available to help out in anyway?
Yes
No
Maybe
I give my permission for my child to participate in this activity off school property (around the town of Richmond).
*
Yes
No
My child has asthma and has permission to self-medicate with an adult present at the start of the activity. The inhaler will be in his/her backpack. The nurse’s office is closed after school and I understand that there will be no nurse present.
*
Yes
No
Not Applicable
Proceeds from this event will go to support RES Grade Level Teams
All checks can be made out to RES attn: Powder Run and brought to school prior to the event or mailed to Richmond Elementary School 125 School Street, Richmond VT, 05477
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