Registration Form

School(s)

School District

How is your school or district celebrating Every Kid Healthy Week? (Select all that apply) Hosting a wellness eventIntegrating health into classroom lessons/activitiesSharing wellness tips or announcementsLaunching a school-wide health challengeOffering healthy meals, snacks, or taste testsEngaging families in health-promoting activitiesPromoting Every Kid Healthy Week on social mediaOther

If you are hosting an event, what type of Every Kid Healthy Week event will you host? Health Fair Family Fitness Day Field Day Taste Test School Garden Activities Fun Run/Walk School Health Mural/Beautification Playground Refurbishment Other

Event Description

City

State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip

Primary Contact Title

Primary Contact First Name

Primary Contact Last Name

Primary Contact Email

Primary Contact Phone

Number of Expected Students

Number of Expected Parents/Family Members

Number of School/District Representatives/Staff

Number of Community Representatives

Do you plan to recruit volunteers to help support your event? Yes No Unsure

Will any community leaders or VIP guests attend the event? (Select all that apply) None expected Local Government RepresentationOrganization LeadersSuperintendentState/National Government RepresentativesOther

Media Promotions None Local Newspaper Local Broadcast TV News/Radio School Newsletter School Website Social Media Other

Do you plan to serve a healthy snack or include a healthy snack activity for your event? Yes No Unsure

Is this your first time hosting an Every Kid Healthy Week event? Yes No Unsure

How did you hear about hosting an Every Kid Healthy Week event? Current/former school grant recipient State or project coordinator Another school/district State agency Partner organization Action for Healthy Kids newsletter Action for Healthy Kids social media Action for Healthy Kids website National Observance calendar Friend/family member Other

Would you like to learn more about Action for Healthy Kid’s programs and services? (Select all that apply) NoYes: AllYes: Professional Development Yes: Resource DevelopmentYes: Technical AssistanceYes: Research and Evaluation Yes: School Health Infrastructure Yes: NutritionYes: Mental Health and WellnessYes: Physical Activity Yes: Vaping/Nicotine PreventionYes: Health Education

Please share any additional, unique or interesting news about your school's/district's health/wellness program that we might share with your local media.

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