Have a great 2011-12 school and sports year
See you Summer, 2012

Youth Sign-Up -- Form [Merrimack]

To participate in the 2011 Youth Speed and Conditioning Program, complete the form below. You may submit it online by clicking the Submit Profile Form button. Or, you may print and mail it with your payment, made out to Going the Distance, 81 Main Street, Peabody, MA 01960. Or, you may bring it to the first session.
You also may submit payments via PayPal by going to the Going the Distance Youth Program Payments page.

Participant's Name(s):
Address:
City/State/Zip:
Date of Birth(s):
Age(s) on June 13, 2011:
Home Phone:
Emergency Phone:
Parents' E-mail address:
Favorite Sport:
Current Health (include any current injuries or health concerns):
Additional Information:
Program Fees per Family: 1 Child, $100
2 Children, $190
3 Children, $270
4 or more Children, $340
Payment Choice: I am paying via PalPay
I am sending a check or bringing it to the track
Signature:

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