Kaiser Permanente Youth Fitness Program
Sign-up Sheet and Distance Report
Please print clearly.
1. Fill out your contact information.
2. List the names of the participants.
3. As each cumulative distance (5 km= 3.1 miles, 10 km=6.2 miles, half marathon =13.1 miles, or marathon=26.2 miles) has been run, check the appropriate space and...
4. Mail a copy of the log to the contact address on the reverse of this brochure. You may photo-copy this form or create your own sheets.
5. For each cumulative distance run, the CIM will provide the participant a special ribbon printed with the distance achieved.
Name of Teacher, Coach, or Parent_______________________________________________________________
Name of School or Group __________________________________Grade/Age_____
Address _____________________________________________________________
City ________________________________________________________________
State ________ Zip _________________Phone ______________________________
e-mail _______________________________________________________________
Participant's Name Miles: 3.1 6.2 13.1 26.2
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