Challenge Registration Form

GET REGISTERED! Directions: Please provide the following information below. (If you are registering on behalf of a team, please choose one person to be your key contact.)

Directions: Check one of the following boxes.




I am registering for this challenge on behalf of myself. While I may involve my friends along the way, I have decided to complete the 5 Promises Challenge as an individual.




I am registering for this challenge on behalf of a group of young people. (e.g. a student organization, team, club, etc.)

If you checked this box:

First Name:

Last Name:

Address: City:

State:

Zip:

•

What is the name of your group?

Phone Number:

School Name:

•

How many people are involved with this group?

Birthday:

Email Address:

•

What is your role within this group? (e.g.: captian, chair, prez.)

CHOOSE YOUR PROJECTS!

Directions: Please check one box for each of the 5 Promises to indicate which project you plan to complete. Listed below are the projects made available by our Alliance Partners. If you decide to create your own project that fulfills one of the 5 Promises, please check the “Other” box, and list on the line next to it what you intend to do. In the box titled “Share your plan!” provide for us any additional details you have determined right now about the projects you selected to complete.

PROMISE

1

Caring Adults

PROMISE

2

Safe Places

PROMISE

3

Healthy Start

PROMISE

4

Effective Education

PROMISE

5








Absolutely Incredible Kid Day Big Brothers Big Sisters Family Volunteer Day Thank Your Mentor Day Other: ___________________________

1. Share your plan!








Lights On Afterschool Advocate for Play i-MENTOR Program Youth Traffic Saftey Month Other: ___________________________

2. Share your plan!








March of Dimes WalkAmerica Host a Health Fair Positive Choice Program Prevent Teen Pregnancy Other: ___________________________

3. Share your plan!








Common Cents Groundhog Job Shadow Day Semester of Service Give Kids Good Schools Other: ___________________________

4. Share your plan!





Global Youth Service Day Kids Care Clubs

5. Share your plan!





Red Kettle Collections Other: ____________________________

Opportunities to Help Others
Presidents Volunteer Service Awards

Once completed return this form either...

by mail:

by email:

America’s Promise Alliance [email protected] Attn: Katie Peters 909 N. Washington Street, Suite 400 Alexandria, VA 22314-1556

by fax: 703.535.3903