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Make A Reservation at the Kansas Learning Center for Health

Subject:* Reservation Request

School Name:*

Address:*

Address 2:

City:*

State:*

Zip:*

USD:*

County:*

Teacher Name:*

Grade:* Pre-School Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

Phone:*

Email:*

# of Students Attending:*

# of Adults Attending:*

Programs
At the Center: Half Day: (2) 1-hr programs or (1) 2-hr program
Full Day: (4) 1-hr programs or (2) 1-hr programs & (1) 2-hr program or (2) 2-hr programs

Select Program > 1 hr: Dental (Pre-K to 2nd) 1 hr: Handful of Healthy Habits (Pre-K to 4th) 1 hr: Bones & Muscles (K to 4th) 1 hr: Nutrition I (K to 4th) 1 hr: Nutrition II (5th to 6th) 1 hr: Digestive System (3rd to 7th) 1 hr: Circulatory System (4th to 7th) 1 hr: Respiratory System (3rd to 7th) 1 hr: Nervous System (5th & 8th) 1 hr: Eating In Style (7th to 12th) 2 hr: Lilfe's A Gamble (8th to Adult) 2 hr: Health Ed - 505 (Adult) 2 hr: Puberty (5th & 6th) 2 hr: Mean Streets of Middle School (5th to 6th) 2 hr: Human Growth and Development (5th to 7th) 2 hr: Drugs: Choice or Chance (3rd to 5th) 2 hr: In The NO with Drugs (6th to Adult) 2 hr: Dating Dilemma (8th to Adult)
Select Program > 1 hr: Dental (Pre-K to 2nd) 1 hr: Handful of Healthy Habits (Pre-K to 4th) 1 hr: Bones & Muscles (K to 4th) 1 hr: Nutrition I (K to 4th) 1 hr: Nutrition II (5th to 6th) 1 hr: Digestive System (3rd to 7th) 1 hr: Circulatory System (4th to 7th) 1 hr: Respiratory System (3rd to 7th) 1 hr: Nervous System (5th & 8th) 1 hr: Eating In Style (7th to 12th) 2 hr: Lilfe's A Gamble (8th to Adult) 2 hr: Health Ed - 505 (Adult) 2 hr: Puberty (5th & 6th) 2 hr: Mean Streets of Middle School (5th to 6th) 2 hr: Human Growth and Development (5th to 7th) 2 hr: Drugs: Choice or Chance (3rd to 5th) 2 hr: In The NO with Drugs (6th to Adult) 2 hr: Dating Dilemma (8th to Adult)
Select Program > 1 hr: Dental (Pre-K to 2nd) 1 hr: Handful of Healthy Habits (Pre-K to 4th) 1 hr: Bones & Muscles (K to 4th) 1 hr: Nutrition I (K to 4th) 1 hr: Nutrition II (5th to 6th) 1 hr: Digestive System (3rd to 7th) 1 hr: Circulatory System (4th to 7th) 1 hr: Respiratory System (3rd to 7th) 1 hr: Nervous System (5th & 8th) 1 hr: Eating In Style (7th to 12th) 2 hr: Lilfe's A Gamble (8th to Adult) 2 hr: Health Ed - 505 (Adult) 2 hr: Puberty (5th & 6th) 2 hr: Mean Streets of Middle School (5th to 6th) 2 hr: Human Growth and Development (5th to 7th) 2 hr: Drugs: Choice or Chance (3rd to 5th) 2 hr: In The NO with Drugs (6th to Adult) 2 hr: Dating Dilemma (8th to Adult)
Select Program > 1 hr: Dental (Pre-K to 2nd) 1 hr: Handful of Healthy Habits (Pre-K to 4th) 1 hr: Bones & Muscles (K to 4th) 1 hr: Nutrition I (K to 4th) 1 hr: Nutrition II (5th to 6th) 1 hr: Digestive System (3rd to 7th) 1 hr: Circulatory System (4th to 7th) 1 hr: Respiratory System (3rd to 7th) 1 hr: Nervous System (5th & 8th) 1 hr: Eating In Style (7th to 12th) 2 hr: Lilfe's A Gamble (8th to Adult) 2 hr: Health Ed - 505 (Adult) 2 hr: Puberty (5th & 6th) 2 hr: Mean Streets of Middle School (5th to 6th) 2 hr: Human Growth and Development (5th to 7th) 2 hr: Drugs: Choice or Chance (3rd to 5th) 2 hr: In The NO with Drugs (6th to Adult) 2 hr: Dating Dilemma (8th to Adult)

Programs
On the Road: Select Program > On the Road (K to 5th) On the Road (K to 6th) On the Road (6th to 9th) On the Road (6th to 12th)

1st Date
Choice:*

2nd Date
Choice:*

3rd Date
Choice:*

Time:* 8 AM 9 AM 10 AM 11 AM 12 AM 1 PM 2 PM 3 PM

Other Information: