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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Email *
First Name *
Middle Name *
Last Name *
Birth Date *
Current Age *
Address (include Apartment/Suite #) *
City *
State *
Zip Code *
Gender *
Phone number *
Current Shirt Size *
Current Shoe Size (number) *
Current School (attended) *
Current Grade in School *
Race *
Current Fitness Level *
What are some of your goals for our program? *
What are some of your life goals? *
Emergency Contact #1 (First & Last name) *
Phone Number - Emergency Contact #1 (XXX-XXX-XXXX) *
Emergency Contact #2 (First & Last name) *
Phone Number - Emergency Contact #2 (XXX-XXX-XXXX) *
Average household Income *
How many people live in your household (including parents, siblings, or bodies that regularly live under the same home)?  (ENTER A #) *
Are you requesting a pair of shoes to be donated to the participant by a donor? *
Current Shoe Size (if requesting a pair)
If you answered YES above, why are you requesting a pair be donated? What circumstances lead to the participant needing a pair of shoes?
If you answered NO above, are you willing to donate to help a kid in need get their pair?
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A copy of your responses will be emailed to the address you provided.
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