KCWH TCWH - School Interest Form

Kids or Teens Cook With Heart School Interest Form

If you are a principal or teacher interested in bringing Kids Cook With Heart or Teens Cook With Heart to your school, please complete the following interest form.

Step 1: School Information
School Name: *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
School website: *
Your Full Name *

First Name Last Name
E-mail *
Your Position at the School: *

Principal Teacher
If you are a teacher, please provide the following:
Name of Principal:
Phone Number

Area Code Phone Number
E-mail
Our school participates in the following AHA programs/events:

Jump Rope For Heart Hoops For Heart Go Red For Women Be The Beat / CPR Other
Our school would like more information about:
Section 2: Curriculum Integration
1. Grades Please indicate what grades you would like to participate *
Time of day:

During school After school
2. Please mark all the subject area(s) in which you would incorporate Kids Cook with Heart / Teens Cook With Heart. (Check all that apply.)

Math Science Social Studies History Health/ Nutrition Language Arts Music Physical Education Environmental Eduation Other
Should be Empty: