Form
#BLUESOMEGOOD
School name
Main point of contact
First Name
Last Name
Email
example@example.com
School address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone
Please enter a valid phone number.
Would you like a mental health assembly during Children's Mental Health Week? Please specify which dates are most suitable
Monday 3rd February
Tuesday 4th February
Wednesday 5th February
Thursday 6th February
Friday 7th February
Previous week
Would you like Dexter the therapy dog to visit your school? (He will try to visit as many schools as possible)
Yes
No
I'm not sure
Will you be fundraising?
Yes
No not at this time
Maybe but I would like more information
How many children are on roll at school?
What age group attends your school?
eg: Primary/Secondary
Submit
Should be Empty: