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Become a Running Kid Today
Fill this form out to register as a member of Running Down A Dream 501(c)(3)'s Organization
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* Indicates required question
Email
*
Your email
First Name
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Your answer
Middle Name
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Your answer
Last Name
*
Your answer
Birth Date
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MM
/
DD
/
YYYY
Current Age
*
Your answer
Address (include Apartment/Suite #)
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Gender
*
Male
Female
Prefer not to say
Phone number
*
Your answer
Current Shirt Size
*
Youth S
Youth M
Youth L
S - Adult Small
M - Adult Medium
L - Adult Large
XL - Adult Extra Large
XXL - Adult Extra Extra Large
Current Shoe Size (number)
*
Your answer
Current School (attended)
*
Your answer
Current Grade in School
*
Choose
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Freshman (High School)
Sophomore (High School)
Junior (High School)
Senior (High School)
Race
*
White
Hispanic or Latino
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Current Fitness Level
*
Not active at all (no recent experience run/walking)
Somewhat active (can run/walk a mile with little-no issues)
Moderately active (can run/walk 2 miles with little-no issues)
Active (Can run/walk 3 miles with little-no issues)
Very Active (can run/walk more than 4 miles)
What are some of your goals for our program?
*
Your answer
What are some of your life goals?
*
Your answer
Emergency Contact #1 (First & Last name)
*
Your answer
Phone Number - Emergency Contact #1 (XXX-XXX-XXXX)
*
Your answer
Emergency Contact #2 (First & Last name)
*
Your answer
Phone Number - Emergency Contact #2 (XXX-XXX-XXXX)
*
Your answer
Average household Income
*
Less than $20,000
$20,000 to $40,000
$40,000 to $60,000
$60,000 to $80,000
$80,000 to $100,000
$100,000 to $125,000
$150,000 to $175,000
$175,000 to $200,000
$200,000 to $250,000
$250,000 to $350,000
$350,000 to $500,000
Over $500,000
How many people live in your household (including parents, siblings, or bodies that regularly live under the same home)? (ENTER A #)
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Your answer
Are you requesting a pair of shoes to be donated to the participant by a donor?
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Yes
No
Current Shoe Size (if requesting a pair)
Your answer
If you answered YES above, why are you requesting a pair be donated? What circumstances lead to the participant needing a pair of shoes?
Your answer
If you answered NO above, are you willing to donate to help a kid in need get their pair?
Yes
No
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A copy of your responses will be emailed to the address you provided.
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