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Beryle Lantz
2018-2019
 
       
       
 
   
 
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Elkhorn Optimist Club - 2019 Punt, Pass and Kick Registration
Boys and Girls Ages 6 -15 Parents authorize participation for this event by completing the adult part of the registration. PLEASE be certain to include AGE, BIRTH DATE and GENDER for each child.

Enter Contact Information Below (Fields in red are required)
Yes, make this a contact person for registration announcements and reminders. *Email address will be required below.
Registering as

Adult - I AUTHORIZE and WILL ATTEND with my child
Adult - I AUTHORIZE but WILL NOT ATTEND with my child
Youth - I am registering as a participating YOUTH
Adult Optimist Member/Guest - I am an Optimist Member or Guest
First Name of this registrant
Last Name of this registrant
Gender
Email *Required only if contact person
Date Of Birth
Month: Day Year
Home/Main Phone
Reminder Preference
Is this your first Optimist event? Yes    No
Please describe any special
accommodations needed.

Do you have a registration code?
If you've been instructed (or required) to enter a registration code, please enter it here.
 

Additional Contact Information
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Address Cont'd
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