KIDS ON THE BLOCK ONLINE PRESENTATION REQUEST FORM

This form must be completed by a school administrator and/or the administrator of a community centre.
For questions contact Sharon Otto at sharon@edmontonepilepsy.org.
Your School or Community Centre Name *
Your Full name *
Your Title *
Email *
What grades are you requesting the presentation for? (select all that apply) *
Required
How many students/children would be watching the show in total?
FIRST CHOICE - What date are you hoping to book the presentation for? (consider providing us at least three week notice) *
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SECOND CHOICE - What date are you hoping to book the presentation for? (consider providing us at least three week notice)
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What time are you hoping to book the presentation for? *
Time
:
Submit
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