Vids4Kids Pre-Registration

Welcome to the Vid4Kids 2023 Program

Please take a moment to complete the following pre-registration questionnaire and when done, hit the "Submit" button to send to us. Someone will be back in touch with you shortly to confirm your details and discuss arrangements for implementing Vids4Kids at your site.
Please note: required fields that have an asterisk need to be completed for the form to be sent

1) Site Name, Site Address, Names, Emails, Site Phone Numbers
(Please manually enter all your data - be sure to fill all fields in order to submit the form)

* Indicates required field

Site Name *

Site Street Address *

Site Town/City *

Site State *

Site Zip Code *

Site Contact Person *

Contact Person Email *

Site Phone Number *

2) New to our Program?

Yes or No *

3) Have you signed and submitted our Memorandum of Understanding?
(If not.....click link at bottom of this form to download, then complete, sign and send to Rana Kirkland)

Yes or No *

4) Are you or site staff interested in attending the mini-training course for Youth Wellness
certification?

Yes or No *

5) Other contacts and their email address (if different from above) to receive your audio/video links, nutrition deliveries and/or site resource for teacher visits when scheduled:

Please be as specific as possible *

6) How many students are located at your site and on average are potentially available for these classes on a daily basis?

Total Number of Students *

Average Available Daily *

7) What is the median age of the students who might attend our classes?

Median Age of Students *

8) Any general questions or requests please note below

Comment *

I agree to receiving marketing and promotional materials

Submit

ofh_online_mou_010623.docx.pdf
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File Type:	pdf

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