CHEC Program E-Scheduling Form
Please complete the following information and then click the Submit button, to send a Field Trip Request. A CHEC representative will contact you to confirm the details of your visit. Thank you!
* = Required Information
School Information
School or Organization:
*
Street Address:
*
City:
*
Zip Code:
*
School District:
*
Contact Information
Contact Name:
*
Email:
*
Phone:
*
-
-
Student Group Information
We reserve the right to combine groups for field trip programming at CHEC.
Number of Students:
*
Max = 60 at CHEC or 35 at your school
Grade Level:
*
K3
K4
K5
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Select an Event * from either of the two lists.
(
map
)
Your Group visits CHEC:
Alcohol, Tobacco & Other Drugs I
Alcohol, Tobacco & Other Drugs II
Bodies Alive
Circulatory System
Dental Health
Digestive System
Energy Extreme
Health Supply
Keeping Clean is Good Hygiene
Nervous System
Respiratory System
Safe Ways, Safe Words
Safety and Injury Prevention
Sensational Senses
Skeletal and Muscular System
Some Body
Surviving Adolescence
Teen Transitions
The Power of Me
-OR-
CHEC visits your school:
Body Basics I
Body Basics II
Eat to Live I
Eat to Live II
FIXIT: Bullying
FIXIT: Communication
Get Movin' I
Get Movin' II
Growing Boys
Growing Girls
HIP Careers: Dentistry
HIP Careers: Nursing
HIP Careers: Radiology
Safety on the Go!
Surviving Adolescence: Pressure
Surviving Adolescence: Respect
Surviving Adolescence: STI's
Teen Depression
Terrific Tykes
From the 4 sub topics of
Surviving Adolescence
,
please select any
2
.
Contraception
Respect in Relationships
Pressure
Sexually Transmitted Infections
Select the Event Date
Date
Time
*
Date/Time Choice #1:
9:30 AM
11:00 AM
12:30 PM
Date/Time Choice #2:
9:30 AM
11:00 AM
12:30 PM
Date/Time Choice #3:
9:30 AM
11:00 AM
12:30 PM
Are there any other details to coordinate?
Lunch Room Request:
Not Needed
Before Program
After Program
Questions / Comments:
Max Length: 300 characters
Character Count:
