Social Distancing Distance Club (Chinle Area) Registration
For middle-school-aged youth and their siblings living under the same roof in the Chinle IHS service unit. Up to four household members can be registered with the submission of one form. Please leave sections for participants #2-4 blank if there are not multiple registrants in your household. If your household has more than 4 members participating together, please complete this form and then start a new one listing only those participants that have not already been registered. Thank you.
Participant #1's First Name *
Participant #1's Last Name *
Age *
Grade *
Gender *
School They Attend *
Participant #2's First Name
(if applicable)
Participant #2's Last Name
(if applicable)
Age
Grade
Gender
Clear selection
School They Attend
Participant #3's First Name
(if applicable)
Participant #3's Last Name
(if applicable)
Age
Grade
Gender
Clear selection
School They Attend
Participant #4's First Name
(if applicable)
Participant #4's Last Name
(if applicable)
Age
Grade
Gender
Clear selection
School They Attend
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