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YES!  I would like to part of the ALL STARS! To be a part of this exciting program, just print out and fill out the information on the ALL STARS form.  Send to: Malinda Riley Valley Community Coalition P.O. Box 181 Clermont, Iowa 52135 Questions? Contact Malinda Riley Youth Coordinator - Malinda Riley - 423-5171

___________________________________________________________ Parent's Names ___________________________________________________________ Child's Name ___________________________________________________________ Address ___________________________________________________________ Phone ________________________               ___________________________ Child's Age                                              Grade ______________________________________      __________________ Parent Signature                                                             Date