School: *
Contact Name: *
Contact Phone #: *
Fax #:
Please indicate the best time to reach you:
Email: *
Total Grade 7 Presentations Needed: NoneUnsure12345+
Please indicate Grade 7 class types (e.g. 2 co-ed, 1 male-only, 1 female-only):
Total Grade 8 Presentations Needed: NoneUnsure12345+
Please indicate Grade 8 class types (e.g. 2 co-ed, 1 male-only, 1 female-only):
Total Grade 9 Presentations Needed: NoneUnsure12345+
Please indicate Grade 9 class types (e.g. 2 co-ed, 1 male-only, 1 female-only):
Total Grade 10 Presentations Needed: NoneUnsure12345+
Please indicate Grade 10 class types (e.g. 2 co-ed, 1 male-only, 1 female-only):
Average Class Size: 10-1920-2930-3940+
If not Healthy Living or Healthy Active Living Education courses, please specify course:
Class length (in minutes): *
Preferred Presentation Dates: *
How did you find out about THRIVE Ottawa? * Mail-outFirst Place Pregnancy CentrePersonal ContactOther
If 'Personal Contact' or 'Other', please explain:
Please express any other questions, concerns, or special requests here:
............................................ A representative from the THRIVE Community Education Program will contact you shortly to discuss further details. Thank you!