Kansas Department of Health and Environment: Kansas Kids' Fitness Day

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Kansas Kids' Fitness Day

2010 Kansas Kids' Fitness and Safety Day School Registration Form

Our school would like to participate in Kansas Kids Fitness and Safety Day on May 7, 2010. The number of third grade students expected to attend from our school:

We would like to participate in the following manner, please place an "X" for all that apply:

Attend the flagship site at Cedar Crest on May 7, 2010. I understand that participants will be selected on a lottery basis. Applications must be submitted by December 30 to be included in the lottery.You will be notified early February whether your school was accepted to attend the Cedar Crest Host Site).

Attend the flagship site at Fort Larned on May 7, 2010. We understand the participants will be selected on a lottery basis for either the morning or afternoon session. We would prefer the following session: Morning: Afternoon:
(Applications must be submitted by December 30 to be included in the lottery. You will be notified early February whether your school was accepted to attend).

Attend a Host Site in our area. We will need information on Regional Host Sites that we can attend. (A list of Host sites will be sent to you early February)

We will be participating at the Host Site in our area that we go to every year. The name of our Host Site is:

Host site: Site Coordinator, if known:

We will be unable to attend any event this year but please include me in your communications for next year.

**Please note, you will also need to contact your Host Site to let them know you plan on attending.

School Contact Person:

Name:

E-mail:

Phone:

Fax:

Address:

School:

City:

Zip:

Principal or Authorizing Official Signature:

PLEASE COMPLETE AND RETURN THIS FORM BY DECEMBER 30, 2009

You may also fax or e-mail to: 785-296-8059 or jchurch@kdheks.gov.