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School Health Request Form

The School Health Team supports schools in Huron and Perth counties to improve the health of students and the school community using a comprehensive school health approach. Complete this form to request a curriculum kit, presentation or program available to schools from Huron Perth Public Health.

Request submitted by:

School:

Grade(s):

Number of students:

Email address:

Daytime phone number:

What is your preferred time and day to be contacted?

I am interested in obtaining the following programs or teaching kits (check if interested):

Food and nutrition | Rainbow Food Explorers curriculum kit (Gr. K-3)

Human development | Puberty kit (Gr. 4-6)

Infection control | Handwashing lesson plan | Glo Germ kit (Gr. K-3)

Oral health | 2 for 2 oral health curriculum kit (Gr. K-2)

Physical activity | Playground Activity Leaders in Schools (PALS) program materials (Gr. 4-6)

Sexual health | Birth control presentation (Gr. 7-12)

Sexual health | Question & Answer presentation (Gr. 7-12)

Sexual health | Sexually Transmitted Infections presentations (Gr. 7-12)

Substance use/vaping | My Brain, My Choice teaching kit (Gr. 6)

Your privacy

Any personal information or personal health information submitted on this form will be collected, used and disclosed by Huron Perth Public Health staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990 or the Personal Health Information Protection Act, 2004, S.O.2004, where applicable. Any information you share will be used only for the delivery of public health programs and services; de-identified information may be used for evaluation or statistical purposes. Questions about this collection of information should be directed to the Privacy Officer of Huron Perth Public Health by calling 1-888-221-2133 or emailing privacy@hpph.ca.

Forms

School Health Request Form

Your privacy