Fresh Fruits and Vegetable Training Registration Form: Thousand Oaks & Simi Valley Spring 2013

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Thanks for your interest in the Centerpiece for a Healthy School Environment Fresh Fruits and Vegetable Seasonal Training on April 11th & 12th. This training will provide a refreshing and dynamic workshop space for exploring farm to school, garden enhanced nutrition education, innovations in working with the new rules and regulations for your school meal programs, and much more! Please provide us with the following information below. We'll be emailing you a confirmation note with logistic details and basic agenda the week preceding the training. If you have any questions please feel free to email or call Tim Galarneau at tgalarne@ucsc.edu or 831-359-8861.

*Lunch will be available for $5 prepared by Joe Cook, our host Conejo Valley USD Nutrition Food Service Director, if you're interested on Day 1!

First Name *

Last Name *

Name of your School or Organization *

Name of your School District, if relevant

County you work in *

List the county you primarily work in

Select your primary role in supporting a Healthy School Environment *

Check the best answer (we know it is hard to fit everything you do in one little box)

Educator - Garden Educator

Educator - Nutrition Educator

Food Service Professional

Farm to School Promoter

Teacher - Elementary (k-5)

Teacher - Secondary (6-12

Teacher - Preschool/daycare

Administrator - School, District or Business

Community Volunteer

Produce Grower/Marketer

Other:

Job Title *

Email *

Please check spelling for accuracy

Phone *

xxx-xxx-xxxx

Select workshop location: *

This form is for registering at the location below only. If the option below says "WAITLIST," then the workshop is full. Complete this registration form and we will contact you if space opens.

Thousand Oaks April 11th-12th

Which days of the workshop will you be attending? *

Day One

Day Two

Both Days

Is your school a current Fresh Fruit and Vegetable Program Grant Recipient? *

yes

I don't know

Are you a Network for a Healthy California contractor or program? *

yes

I don't know

Is your agency a Shaping Health as Partners in Education (SHAPE) member? *

yes

I don't know

Have you attended a FFVCHSE Training(s) in the Past?

If you have attended a training in the past please list the training(s), if not leave blank. [2012 SPRING: Bakersfield - Fresno - Hayward - Los Angeles - East Palo Alto - Ukiah] __[2011 FALL: Bakersfield - Fresno - Hayward - Los Angeles - San Francisco - Ukiah] __ [2011 SPRING: Chico - Glendale - Merced - San Marcos - San Jose - San Luis Obispo - San Rafael - Ventura - Woodland] __ [2010 FALL: Chico - Glendale - Merced - San Marcos - San Jose - San Luis Obispo - San Rafael - Ventura - Woodland] __ [2010 SPRING: Davis - Downey - Fresno - Hayward - Redding - Rialto - Salinas - San Diego - Santa Ana - Santa Rosa] __ [2009 FALL: Davis - Downey - Fresno - Hayward - Redding - Rialto - Salinas - San Diego - Santa Ana - Santa Rosa]

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