BJC School Outreach & Youth Development

scheduling

Call 314.286.0460 or use this form to contact our school/community health coordinator. Together we’ll schedule a program or design an interactive session that appeals to your students and meets the educational needs of your curriculum.

We know your time is valuable; the more complete you make this form, the more prepared we will be when we speak with you.

* = Required Field

Title:

*First name:

*Last name:

* Please give us a way to contact you.

	Telephone:
	Fax:
	E-Mail:

*Address:

Address line 2:

*City:

*State:

ZIP/Postal:

You may mail information to me. yes no

Please tell us about your students.

School or Organization:
Number of Students in Each Class:
Number of Presentations Desired:
Average Age of Students:
Average Grade Level of Students:
Programs of Interest

Start Time(s) of Your Class(es)
Presentation Dates Desired:

Comments and Questions


Copyright 1997-2006 All Rights Reserved	Search \| Contact Us \| Our Policies \| BJC HealthCare