YOUNG WORKER AWARENESS PROGRAM BOOKING FORM

Please complete this form in its entirety. Be sure to include your individual phone extension number. As demand can outstrip our delivery capacity, please contact us well in advance of your desired presentation date.

* Indicates a required field

Name of School*:

Address*:

Town*:

Province:

Postal Code*:

School Phone*:

School Fax:

Name*:

Liaison Phone*:

Ext:

Liaison Fax:

Liaison Email*:

Do you require a French presentation?*:

How many presentations do you require?:

Date*:

Start Time*:

End Time*:

# of Students*:

Class Type*:

If Other please specify:

Date:

Start Time:

End Time:

# of Students:

Class Type*:

If Other please specify:

Alternative Date Option 1:

Alternative Date Option 2:

Alternative Date Option 3:

# of Students:

Class Type:

If Other please specify:

Note: YWAP presentations can be adapted to various classroom period time lengths.

Preferred Presenter:

Note: We do our best to accommodate specific requests for individual presenters, but we cannot guarantee them.

Additional Comments:

If you have any questions or would like further information,
please contact YWAP Co-ordinator.
Phone: 416.441.1939, extension #8809
Toll Free: 1.888.869.7950
E-mail: ywap@whsc.on.ca
Fax: 416.441.0399

Maintenance Message

Workers Health & Safety Centre

YOUNG WORKER AWARENESS PROGRAM BOOKING FORM

Name of School*:

Address*:

Town*:

Province:

Postal Code*:

School Phone*:

School Fax:

Name*:

Liaison Phone*:

Ext:

Liaison Fax:

Liaison Email*:

Do you require a French presentation?*:

How many presentations do you require?:

Date*:

Start Time*:

End Time*:

# of Students*:

Class Type*:

If Other please specify:

Date:

Start Time:

End Time:

# of Students:

Class Type*:

If Other please specify:

Alternative Date Option 1:

Alternative Date Option 2:

Alternative Date Option 3:

# of Students:

Class Type:

If Other please specify:

Note: YWAP presentations can be adapted to various classroom period time lengths.

Preferred Presenter:

Note: We do our best to accommodate specific requests for individual presenters, but we cannot guarantee them.

Additional Comments: