Request edit access
5th/6th Grade Kernel Klub Girls' Basketball
2024 Kernel Klub Girls' Basketball
Sign in to Google to save your progress. Learn more
Email *
First and Last Name of Athlete
*
Current Grade  *
What elementary school are you currently attending, or did you attend last year? *
Parent #1 First and Last Name *
Parent #1 Cell Number *
Parent #2 First and Last Name
Parent #2 Cell Number
Does your child need transportation after school, by bus, to get to the designated practice gym?  This will either be at Longfellow or LBW after registration is complete. *
T-shirt Size *
Are there any medical concerns to be aware of at this time? Say "No" below, or explain in detail. 
*
I acknowledge and consent to my child's participation in the Kernel Klub program organized by the Mitchell School District. I understand and accept the inherent risks associated with this activity and willingly release the Mitchell School District and its coaches from any liability, claims, or demands arising from my child's participation in the program. I affirm that I understand the terms and conditions of this physical activity.
*
I agree to pick-up my child by 5:00pm at the designated location from all practices and games during this four week Kernel Klub session.
*
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of State of South Dakota K-12 Data Center.

Does this form look suspicious? Report