Please indicate whether your group will use bus transportation if provided from your region.

*Please note: Pick-up times may be early morning

Each group is guaranteed space for 7 people to attend, one of which must be an adult chaperone. However, we anticipate that there will be additional room to accommodate more people from each group, so we encourage you to put people on the wait list if there are more than 7 people from your group that want to participate in Kick Butts Day: Take Down Tobacco.

Please be sure to include the grade level of each youth registered. We are piloting middle school programming and keeping track of middle school involvement throughout the year.

If you do not yet know the names of the youth who will attend, please let us know the number of youth you expect to come in the comment box at the bottom of the page.

Note: A copy of signed consent form must be submitted for each youth participant by April 17.

If there are more youth and adults who want to attend Kick Butts Day beyond the six spaces above, please list the names and information below. Any additional registration requests from your group will be placed on a waiting list and immediately notified as space becomes available. We will do our best to include everyone who wants to come!