GET REGISTERED!

Directions: Check one of the following boxes. Directions: Please provide the following information below. (If you are registering on behalf
of a team, please choose one person to be your key contact.)

I am registering for this challenge on behalf of myself. While
I may involve my friends along the way, I have decided to complete First Name: Last Name:
the 5 Promises Challenge as an individual.

Address:

I am registering for this challenge on behalf of a group of
young people. (e.g. a student organization, team, club, etc.)
City: State: Zip:
If you checked this box:
• What is the name of your group? Phone Number: School Name:

• How many people are involved with this group? Birthday: Email Address:

• What is your role within this group? (e.g.: captian, chair, prez.)

CHOOSE YOUR PROJECTS!

Directions: Please check one box for each of the 5 Promises to indicate which project you plan to complete. Listed below are the projects made available by our
Alliance Partners. If you decide to create your own project that fulfills one of the 5 Promises, please check the “Other” box, and list on the line next to it what you intend
to do. In the box titled “Share your plan!” provide for us any additional details you have determined right now about the projects you selected to complete.

PROMISE
Absolutely Incredible Kid Day 1. Share your plan!

1
Caring
Adults








Big Brothers Big Sisters
Family Volunteer Day
Thank Your Mentor Day
Other: ___________________________

PROMISE
Lights On Afterschool 2. Share your plan!

2
Safe
Places








Advocate for Play
i-MENTOR Program
Youth Traffic Saftey Month
Other: ___________________________

PROMISE
March of Dimes WalkAmerica 3. Share your plan!

3
Healthy
Start








Host a Health Fair
Positive Choice Program
Prevent Teen Pregnancy
Other: ___________________________

PROMISE
Common Cents 4. Share your plan!

4
Effective
Education








Groundhog Job Shadow Day
Semester of Service
Give Kids Good Schools
Other: ___________________________

PROMISE
Global Youth Service Day 5. Share your plan!

5
Opportunities

Kids Care Clubs
to Help Others
Presidents Volunteer Service Awards




Red Kettle Collections
Other: ____________________________

Once completed return this form either... by mail: by email: by fax:

America’s Promise Alliance YouthPromise@americaspromise.org 703.535.3903
Attn: Katie Peters
909 N. Washington Street, Suite 400
Alexandria, VA 22314-1556