KBB Alumni Participation Form Student InfoStudent Name(Required) First Last Student Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Birthday(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade(Required) What school do they attend?(Required) Please which program your child is participating in:(Required)Alumni Bike RideAlumni MaintenanceBothDoes your child plan on bringing the bicycle they earned from the program for the ride?(Required) Yes No If your child needs maintenance done to their bike, please describe below the issue: Parent/Family InfoParent/Guardian Name(Required) First Last Parent/Guardian Address (if different than child's) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian Phone(Required)Parent/Guardian Email(Required) Will you or another parent/guardian be joining on the ride?(Required) Yes No Do you own a bicycle that you can bring to use on the ride, or would you need to borrow one from us?(Required) Yes (Bringing my own bike) No (I need a bike to use) N/A (I am not attending the ride) If you need to borrow a bike, please let us know your height. Emergency Contact InformationName:(Required) First Last Phone:(Required)Relationship to Child:(Required) Untitled First Choice Second Choice Third Choice Untitled First Choice Second Choice Third Choice Δ
