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Durham Region P.A.R.T.Y. Program - Registration Form
*
Indicates required field
Teacher Name
*
Teacher's first and last name
Teacher eMail
*
Teacher Cell Phone #
*
What # can you be reached at on day of program?
Total # of Teachers/Supervisors Attending
*
# of adults attending including yourself
School Name and Address
*
How will students travel to program location?
*
School Bus
Transit
Taxi / Ride Share
Walk
Other
Any timing restrictions based on method of travel? Be prepared to arrive by 9:45am and stay until 1:30pm unless otherwise requested.
*
Indicate any restrictions related to method of travel such as school bus is only available 930am-230pm.
Aspect of curriculum the program is being integrated into
*
How does the program fit into the curriculum? eg., Health and Physical Education, Leadership, etc.
# of Students Attending
*
Student Grades (we recommend grades 10 & 11)
*
Grade 9
Grade 10
Grade 11
Grade 12
Submit
Note: A site map will be shared prior to program date.
Home
About
Why Heads Up! Durham
Vision, Mission and Goals
Our Team
Recognition
History
P.A.R.T.Y. Program
What's New
Donate
Concussions
Statistics
Support
Shine a Light on Brain Injury
Contact Us
Print Media
Financial and In-Kind Supporters
Get Involved
In Their Words