The Well Field Trip & Outreach Request Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Name of School or Group
*
Your Relationship to the School or Group
Teacher
Admin
Parent/ Guardian
Other
Program you're interested in
*
Field Trip
Outreach
First choice date of event
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Second choice date of event
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age of children
*
Toddler
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Middle School
High School
Group Size
*
Please select the focus of your program:
*
Nutrition/ Cooking
Physical Activity (dance, yoga, mini circuit, SPARK PE, cooperative games, etc. )
Creative Arts (dance, visual arts, theater, writing, etc.)
Self Esteem/ Teamwork
Mindfulness
Plan to Get Healthy (The Well's signature goal-setting program for students)
Submit
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