Girls on the Run


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Girls on the Run

®

Of Northeast Florida, Inc.

FALL 2013

Registration Information REGISTRATION DEADLINE IS TUESDAY, SEPTEMBER 10 th 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 Place Jacksonville, FL 32216 *MUST BE POST MARKED BY Tuesday, September 10th 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 September 21st and run through December 7th 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 Tuesdays & Thursdays, 4:00-5:15pm





Alimacani Elementary, Jacksonville Mondays & Thursdays, 3:45-5:00pm





Annie R Morgan Elementary, Jacksonville Tuesdays & Thursdays, 3:30-4:45pm 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 Belle Terre Elementary, Flagler County Tuesdays & Thursdays, 3:15-4:30pm



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Brooks Family YMCA, Jacksonville Saturdays, 9:00-11:00am





Chets Creek Elementary, Jacksonville Tuesdays & Thursdays, 3:30-4:45pm





Chimney Lakes Elementary, Jacksonville Tuesdays & Thursdays, 3:30-4:45pm Cunningham Creek Elementary, St. Johns Mondays & Thursdays 3:00-4:15pm Durbin Creek Elementary, Jacksonville Tuesdays & Thursdays, 3:00-4:15pm Fishweir Elementary, Jacksonville Mondays & Fridays, 3:15-4:30pm Fleming Island Elementary, Clay County Saturday, 9:00-11:00am Fleming Island Elementary, Clay County Tuesdays & Thursdays, 2:30-3:45pm

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Garden City Elementary, Jacksonville Tuesdays & Thursdays, 3:15-4:00pm Girls on Track-Buddy Taylor Middle, Flagler Mondays & Wednesdays, 3:30-4:45pm Girls on Track-Fletcher Middle, Jacksonville Wed: 5:15-6:30 & Sat, 10:00am- 11:15am Girls on Track-Ft Caroline Middle Wednesdays & Fridays, 4:15-5:30pm Girls on Track- JWJ Middle School Tuesdays & Thursdays, 3:30-4:45pm Girls on Track-Lake Shore Middle Tuesdays & Thursdays, 4:30-5:45pm 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 Henry F Kite Elementary, Jacksonville Tuesdays & Thursdays, 3:00-4:15pm Hogan-Spring Glen Elementary Mondays & Fridays, 3:30-4:45pm Jacksonville Beach Elementary, Jax Beach Mondays & Wednesdays, 3:15-4:30pm EARLY RELEASE DAYS 1:45-3:00pm Jarboe Park, Jax Beach Saturdays, 9:00-11:00am Julington Creek Elementary, St. Johns Tuesdays, 3:15-5:15pm Kernan Trail Elementary, Jacksonville Tuesdays & Thursdays, 3:15-4:30pm



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Lewis E Wadsworth Elementary, Flagler Tuesdays & Thursdays, 3:30-4:45pm Liberty Pines Academy St Johns Tuesdays & Thursdays, 3:00-4:15pm Losco Park, Jacksonville Tuesdays & Thursdays, 4:30-5:45pm New Berlin Elementary, Jacksonville Mondays & Thursdays, 3:15-4:45pm Ocean Palms Elementary, Ponte Vedra Monday & Wednesdays, 4:30-5:45pm Osceola Elementary, St Augustine Tuesdays & Thursdays, 3:15-4:3pm Parkwood Heights Elementary Mondays & Thursdays, 3:00-4:15pm PVPV Rawlings Elementary Mondays & Wednesdays, 3:00-4:15 Twin Lakes Academy Elementary Tuesdays & Thursdays, 3:00-4:15pm San Jose Episcopal School Fridays, 3:15-5:15pm San Mateo Elementary, Jacksonville Tuesdays & Thursdays, 3:15-4:30pm St Michaels Academy, Nassau county Mondays & Wednesdays, 3:15-4:30pm The Webster School, St Augustine 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 Yulee Elementary, Nassau County Mondays & Wednesdays, 2:15-3:30pm

Step 2: Print participant's information: Participant’s Name: __________________________________ School/GOTR Site: _____________________________ Birth Date: ____________________

Age on 9/21/13: ________

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)

Youth L (14-16)

Adult S

Adult M

Adult L

Adult XL

Adult XXL

GOTR History: 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

$25,000 or Below $25,001 to $50,000 $50,001 and above

$35.00 $55.00 $95.00

Documentation Required (see list below)

Documentation REQUIRED

YES YES NO

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 September 10th 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 December 7th, 2013. 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:

GOTRNEFL REGISTRATION INFORMATION INSIDE: DATE RECEIVED: __________________

PROPER DOCUMENTATION ENCLOSED: YES

NO

COMPLETED: YES

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