Workshop Registration

Please use this form to register your class for a Jr. Medics workshop, which will be offered as two one-hour sessions. Should you wish to register more than one class to our program, we ask that you complete a separate form for each group. The information you provide in this form is strictly confidential and will only be used to assign a team of educators to your class.

Full Name *

First

Last

Email Address *

Phone Number *

School *

Full name of school

School Address *

Address Line 1

City

State / Province / Region

Postal Code

For what grade are you requesting our workshop? *

If you teach a split-grade class, please select all grades you teach.

How many students are in your class? *

What language do you want the session to be taught in? *

Would you prefer the session be taught in person or virtually? (copy) *

At this time, we cannot guarantee that in-person sessions will be offered for the upcoming academic year, but we will try to accommodate your preferences.

If you have any questions about our program or comments you would like to add, please include them below.

By signing below, you are committing to welcoming Jr. Medics volunteers into your classroom during the 2022–2023 academic year. *

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