Bikes For Reading Entry Form Please Enter Your Child’s Information Pleasant Grove Elementary Student's Name* First Last Pleasant Grove Elementary Grade Level*Please select your child's grade levelKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradePlease select your child's grade level Please select your child's teacher*Please select your child's teacherMrs. WootenMrs. TrammellMrs. WinkelmanMrs. Nikou Please select your child's teacher*Please select your child's teacherMrs. BensonMrs. PolcherMrs. AndersonMrs. Chastain Please select your child's teacher*Please select your child's teacherMrs. BookerMr. ReissMrs. PatarekMrs. Miller Please select your child's teacher*Please select your child's teacherMrs. WebbMrs. HobsonMrs. CowellMrs. ReissMrs. Chudyk Please select your child's teacher*Please select your child's teacherMrs. ClarkMrs. HollenkampMrs. KielMrs. Hassett Please select your child's teacher*Please select your child's teacherMrs. HollarsMr. IszerMs. FieldsMrs. Traut Parent/Guardian Name* First Last Parent or Guardian Certification* My child has completed the 50 hours of reading to be eligible for the bike drawing By checking this box, I certify that my child has completed the 50 hours necessary to be entered into the raffle for the free bike. Address* Street Address City State Zip Mobile Phone*Email* Check this box to opt out of updates on how Catalyst Insurance Group is impacting our community.
