FREE Teen Quit Tobacco & E-Cigarette Course
Panhandle Health District offers an in-person quit tobacco and e-cigarette course throughout the five northern counties. This course is designed to address the needs and lifestyles of middle and high school students. The curriculum is designed specifically for teens and is based on the American Lung Association's INDEPTH program. It not only focuses on quitting, but also on social skills, stress management, decision making, goal setting, nutrition and physical activity. The sessions are offered once a week, for four weeks (for a total of four sessions). A certificate of completion is provided at the last class. Registration prior to the course is required.
Please Complete the form below to get registered for our next available session.
Name
*
First Name
Last Name
Student Pronouns
He/Him/His
She/Her/Hers
They/Them/Theirs
Other
Student Gender
*
Female
Male
Non-binary
Other
Name of School Student Attends
Student Age
*
Primary Contact Number
*
Who is the primary contact? (Name)
*
Student Email
*
example@example.com
Parent/Guardian Email (if under 18)
example@example.com
Register for a course
Waitlist for Hayden
What nicotine/tobacco products does student currently use (within last 30 days)?
*
Cigarettes
Cigars
E-Cigarette/Vaping Device (e.g. Elf Bar, Puff Bar, Suorin, etc.)
Hookah
Smokeless Tobacco (e.g. chewing tobacco, snuff, dip, snus)
Other
How long has student been using tobacco products or e-cigarettes?
*
How did you hear about this course?
*
Judge/Juvenile Court Staff
Panhandle Health District Website/Facebook
Previous participant
School Administrator (i.e. Principal, Vice Principal, Dean, etc.)
School Police/Security Officer/Resource Officer
Other
If student is under 18, parent/guardian consents to student enrolling this course.
*
Yes
No
Student over 18
Parent/guardian name
First Name
Last Name
Submit
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