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Spelling Bee Internet Enrollment

This is the champion registration form for the LaPorte County District Spelling Bee. Please register each winner and alternate that will be competing at the Spelling Bee on February 22 at Martin Krueger Middle School in Michigan City. Lake and Porter County school winners need to register on the Scripps website at www.spellingbee.com.

School Champion:

School Champion First Name: *

School Champion Last Name: *

Placement At Bee *

School Name:

School Address:

School City:

School State:

School Zip:

School Corporation: *

Spelling Bee Contact Person at School:

Birth Date: * * *

2011 - 2012 Grade Level: *

Gender: *

Home Address: *

Home City: *

Home State: *

Home Zip: *

Name of Parent/Guardian 1: *

Primary Home Phone Number for Parent/Guardian 1: *

Primary Cell Phone Number for Parent/Guardian 1:

Name of Parent/Guardian 2:

Primary Home Phone Number for Parent/Guardian 2:

Primary Cell Phone Number for Parent/Guardian 2:

Parent/Guardian 1 Email Address:

Verify Parent/Guardian 1 Email Address:

Parent/Guardian 2 Email Address:

Verify Parent/Guardian 2 Email Address: