WalkingWorks for Schools

Registration

Walk with BlueCross WalkingWorks for Schools this Fall!

Thanks for your interest in BlueCross WalkingWorks for Schools. If you are registering after December 21, 2007, your school will be enrolled in the fall semester. Coordinators will receive an e-mail confirming their registration.

NOTE: Materials will be sent toward the end of summer. Coordinators will receive a Teacher Tool Kit for each registered classroom (The Teacher Tool Kit contains: instructional brochure, 30 student wristbands, 2 tracking posters and 1 pedometer). Please be sure to account for all participating classrooms when completing this form.

Questions? Contact Us!

SCHOOL INFORMATION  
   
School Name
School Principal:
School Address, City, Zip:
School County:
School Phone (with area code):
School Fax (with area code):
   
COORDINATOR INFORMATION  
   
Coordinator Name:
Coordinator Address, City, Zip:
(If different than school address. All materials will be sent to this address.)
Coordinator Phone
Coordinator E-mail
 
REGISTRATION INFORMATION  
   
Please tell us how many classrooms per grade are participating:
  
# of Kindergarten Classes:
# of 1st Grade Classes:
# of 2nd Grade Classes:
# of 3rd Grade Classes:
# of 4th Grade Classes:
# of 5th Grade Classes:
For our records, please report the TOTAL number of students participating per school: