Step Up & BWell

First Name

Last Name

Username

Email Address (User)

Email Address (Parent/Guardian)

Your account must have at least one email associated with it, either your own, or a parent/guardian

Password

Confirm Password

Address

City

Zip Code

Mobile Phone

Date of Birth

School

Are you an employee/staff member?

Are you a parent? If checked, this account will be able to manage any additional accounts added below.

What grade are you in?

Height (in inches)

Weight (in lbs)

Parent/Guardian Signature

Clear Signature

By my signature below, I consent to the Saginaw County Health Department’s collection and tracking of various exercise-related data and personal information pertaining to my child, including the use of photographs and/or video(s) in displays or publications to promote the Step Up & BWell program.