Girls on the Run
®
Of Northeast Florida, Inc.
SPRING 2014
Registration Information REGISTRATION DEADLINE IS MONDAY, JANUARY 27th Teams are limited to 20 girls on a First-Come, First-Served basis. Register early to guarantee a spot. TO REGISTER: 1. Go to www.GOTRNEFL.org OR 2. COMPLETE ENTIRE FORM and MAIL IT* ALONG WITH A CHECK OR MONEY ORDER FOR the $95 PROGRAM FEE and ANY REQUIRED DOCUMENTATION(see chart below) to:
Girls on the Run of Northeast Florida 6850 Belfort Oaks P lace Jacksonville, FL 32216 *MUST BE POST MARKED BY Monday, January 27th IN ORDER TO BE ACCEPTED o (This does not guarantee a spot in case a team is already full) Step 1: Check Site preference. Programs begin on or after February 8th and run through April 25th Girls on the Run sites: girls ages 8-11 (3rd-5th grade only): Girls on Track sites: 11-14 (6th-8th grades only)
Abess Park Elementary, Jacksonville Mondays & Thursdays, 4:00-5:15pm
Alimacani Elementary, Jacksonville
Mondays & Thursdays, 3:45-5:00pm
Assumption Catholic, Jacksonville
Wednesdays, 1:30-3:30pm Atlantic Beach Elementary Tuesdays & Thursdays, 4:00-5:15 Bartram Springs Elementary, Jacksonville Tuesdays & Thursdays, 3:00-4:15pm Biltmore Elementary, Jacksonville Tuesdays & Thursdays, 4:15-5:30pm
Chimney Lakes Elementary, Jacksonville Tuesdays & Thursdays, 3:30-4:45pm
Durbin Creek Elementary, Jacksonville Tuesdays & Thursdays, 3:00-4:15pm
Chimney Lakes Elementary, Jacksonville
Girls on Track-Ft Caroline Middle Tuesdays & Thursdays, 4:15-5:30pm Girls on Track-Twin Lakes Academy Mondays & Wednesdays, 4:30-5:15pm Greenfield Elementary, Jacksonville Tuesdays & Thursdays, 3:30-4:45pm Greenland Pines Elementary, Jacksonville Tuesdays & Thursdays, 3:30-4:45pm Hendricks Elementary, Jacksonville Sundays, 3:00-5:00pm J Allen Axson Montessori, Jacksonville Tuesdays & Thursdays, 3:15-4:30pm Jarboe Park, Jax Beach Saturdays, 10:00-12:00noon Julington Creek Elementary, St. Johns Tuesdays, 3:15-5:15pm Kernan Trail Elementary, Jacksonville Tuesdays & Thursdays, 3:15-4:30pm
Tuesdays & Thursdays, 3:30-4:45pm Lewis E Wadsworth Elementary, Flagler Duval Charter-Westside, Jacksonville Tuesdays & Thursdays, 3:30-4:45pm Mondays & Thursdays 3:30;4:45pm Fleming Island Elementary, Clay County Liberty Pines Academy St Johns Saturday, 9:00-11:00am Tuesdays & Thursdays, 3:00-4:15pm Girls on Track-Buddy Taylor, Flagler Mondays & Wednesdays, 3:30-4:45pm Losco Park, Jacksonville Girls on Track-Callahan Middle, Callahan Tuesdays & Thursdays, 4:30-5:45pm Tuesdays & Thursdays, 3:30-4:45pm New Berlin Elementary, Jacksonville Girls on Track-Fletcher Middle, Jacksonville Mondays & Fridays, 3:15-4:45pm MON: 5:15-6:30 & Sat, 10:00am- 11:15am Oceanway Elementary, Jacksonville Tuesdays & Thursdays, 3:15-4:30pm
Osceola Elementary, St Augustine Tuesdays & Thursdays, 3:15-4:3pm
PVPV Rawlings Elementary
Mondays & Thursdays, 3:00-4:15 RB Hunt Elementary Tuesdays & Thursdays, 3:15-4:30pm San Jose Episcopal School Fridays, 3:15-5:15pm San Mateo Elementary, Jacksonville Tuesdays & Thursdays, 3:15-4:30pm San Pablo Elementary, Jacksonville Mondays & Thursdays, 3:15-4:30pm Sheffield Elementary, Jacksonville Tuesdays & Thursdays, 3:30-4:45pm The Webster School, St Augustine Tuesdays & Thursdays, 3:00-4:15pm Twin Lakes Academy Elementary Tuesdays & Thursdays, 3:00-4:15pm
Wards Creek Elementary, St Augustine Thursdays & Fridays, 3:00-4:15pm
Waterleaf Elementary, Jacksonville Tuesdays & Thursdays, 3:15-4:30pm
WD Hartley Elementary, St. Augustine Tuesdays & Thursdays, 3:00-4:15pm
Westview K-8, Jacksonville Tuesdays & Thursdays, 3:30-4:45pm
Yulee Elementary, Nassau County Mondays & Wednesdays, 2:30-3:45pm
Step 2: Print participant's information: Participant’s Name: __________________________________ School/GOTR Site: _____________________________ Birth Date: ____________________
Age on 2/7/14: ________
Grade: ________
Home Address: ___________________________________________________ City: ________________________________________
Home Phone: __________________
State: ___________
NAME
Zip: _________________
WORK PHONE
MOBILE PHONE
Parent/Guardian 1 Parent/Guardian 2 * Parent/Guardian Email(s): __________________________________________________________________ GOTRNEFL will only use email addresses for GOTR program communications
Parent/Guardian Place(s) of Employment: _______________________________________________________ T-Shirt Size: Youth M (10-12) GOTR History:
Youth L (14-16)
Adult S
Adult M
Adult L
Adult XL
Has your daughter participated in Girls on the Run® or Girls on Track during a prior season? Yes
No
Race/Ethnicity Disclosure (Optional; some of our charitable donors collect this information):
White Black Hispanic Asian Multi-Racial Other: ______________________________ Step 3: Please note the Program Fee Scale, send required documentation if necessary, and write a check made payable: “Girls on the Run of N.E. Florida” *Program Fee includes 10 weeks of lessons, all lesson and curriculum materials, certified coaches, t-shirts, water bottle, 5K race supplies and awards. The actual cost of our program is $150 per girl. As a non-profit organization, Girls on the Run of Northeast, FL works diligently to raise funds through grants, individual and corporate donations in order to keep our program fee as low as possible.
Household Income
Program Fee
Documentation Required (see list below)
$25,000 or Below $25,001 to $50,000 $50,001 and above
$35.00 $55.00 $95.00
YES YES NO
Documentation REQUIRED Copy of tax return (for example: 1040, 1040A, 1040EZ) OR Another documentation of income: Three consecutive pay stubs for each wage earner; Social Security SSI Green/Gold Checks; or Unemployment Payments OR Current copy of class schedule, if you are either a part-time or full-time student
NOTE: If you are married, documentation must be submitted for both spouses!
*Please know that your daughter cannot be officially registered unless we have received the Completed Registration Form, Program Fee & ALL Required Documentation by the January 27th deadline! RUNNING BUDDIES: I and/or a family member would like to be a Running Buddy for my daughter at the End of Season 5K on April 26th, 2014. Circle YES
or
NO
I have enclosed an additional $20 for each adult Guardian (18 & older) and $10 for each sibling under the age of 18. Please print the name of each adult and youth Running Buddy below: ___________________________ ___________________________
___________________________
Email: _____________________________Email: ________________________________Email: _____________________________ T- Shirt Size:
__________
T- Shirt Size:
___________
Would you like to donate $10 for our 10 year anniversary*? *Please include it with payment
T- Shirt Size:
YES
___________
NO
FOR GOTR USE ONLY: DATE RECEIVED: __________________ GOTRNEFL REGISTRATION INFORMATION COMPLETED: INSIDE:YES PROPER DOCUMENTATION ENCLOSED: YES
•
NO
NO
REG $ _________
PAYMENT ENCLOSED: $__________ RB $ ___________
• COMPLETE ENTIRE FORM AND MAIL TO GOTRNEFL or REGISTER ON-LINE at www.GOTRNEFL.org (DO NOT hand into site) • It is FIRST COME FIRST SERVE so REGISTER TODAY! Registration is NOT COMPLETE WITHOUT ALL REQUIRED DOCUMENTATION • Be sure to sign up FAMILY RUNNING BUDDIES TODAY TOO! LEARN MORE…GET INVOLVED!
Get involved by coaching a team of girls, helping with a committee, joining our SoleMates fundraising/training team, or sponsoring the girls. You CAN change lives and help girls feel empowered by who they are!
E-MAIL:
[email protected] PHONE: 904.619.6763 WEB SITE: www.GOTRNEFL.org
Girls on the Run of N.E. Florida, Inc 6850 Belfort Oaks Place Jacksonville, FL 32216