Ambassador Kit Request

If you are associated with a school in the ADANE territory, please fill out the form below to request your Fuel Up to Play 60 Challenge Center Activity Kit!

Please note that in order to be eligible to request a kit, you must first:

Name *

First

Last

Email *

If you are under the age of 13, please have a parent or guardian enter their email address. Must be the same email address used to sign-up for the Fuel Up to Play 60 Challenge Center.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Check One *

I am over the age of 13
I am under the age of 13 and I have my parent or guardian's permission to request a Fuel Up to Play 60 Challenge Center Activity Kit

What grade are you currently in? *

1st - 8th
9th - 12th