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Heal the Planet Day Scholarship Application
The cost of the ticket is $3.50. Up to 5 people can enter under 1 family ticket.

*Deadline to submit this form is April 7th, 2019.

First Name *
Your answer
Last Name *
Your answer
Current City *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Name of child at Broward County Public Schools *
Your answer
School that your child attends *
Your answer
Year Level *
Required
Number of People in the Family *
Your answer
How did you hear about Heal the Planet Day? *
Your answer
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