Covenant House Prevention & Awareness
PRESENTATION REQUEST Form


If you are interested in having a presenter come to your school, please submit this form. Please note that submitting this form does not confirm your registration.

*When booking online you are consenting to future emails about our school presentations. You can unsubscribe at any time.

Please ensure that you complete all required fields on the form and format phone/fax and email correctly, or the form will not be submitted. Thank you.

1. Please indicate which presentation(s) you are requesting. Please check all that apply.
* required field
Before You Run
Reality Check
Trafficked
Before You Run & Reality Check Combo
Before You Run & Trafficked Combo
Reality Check & Trafficked Combo

2. School Board:
* required field

3. School or Group Type:
* required field

4. Name of School or Group:
* required field

5. Contact First Name:
* required field

6. Contact Last Name:
* required field

7. Contact Title:
* required field
Principal
Vice-Principal
Chaplain
Social Worker
Child & Youth Worker
Child & Youth Counsellor
Guidance Counsellor
Teacher
Student
Other (please specify)

8. Address of School or Group:
* required field

9. City/Town:
* required field

10. Postal Code:
* required field

11. Phone:
* required field
(Answer must be a validly formed phone number e.g. (999) 555-1234 x12)

12. Phone Ext.:

13. Email:
* required field
(Answer must be a validly formed email address)

14. I prefer to be contacted by:
EmailPhone