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Order activ8
For Parents
*
indicates a required field
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Occupation:
Teacher
Principal
School Administrator
Other:
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Salutation:
Mr.
Mrs.
Miss
Ms.
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First Name:
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Last Name:
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School Board:
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School:
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School Address:
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City/Town:
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Province:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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Postal Code:
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Telephone:
Fax:
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E-mail:
Preferred communications:
Telephone
Fax
E-mail
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Preferred languages:
English
French
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Total number of students in school:
Number of students per grade who will be participating in the program:
JK
K
1
2
3
4
5
6
7
8
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Number of teachers using activ8:
JK-K
1-3
4-6
7-8
*Please note activ8 is available in four modules (JK-K, 1-3, 4-6, 7-8). Supplies are limited and will be fulfilled based on student/teacher ratio.
*
Where did you hear about the activ8 program?
Colleague(s)
Flyer/letter sent to my school
At a conference (please specify)
I’ve used activ8 before
Active Healthy Kids Canada website
Ophea website
Other (please specify)
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