School Health Request Form

The School Health Team supports schools in Huron and Perth counties to improve the health of students and the school community using a comprehensive school health approach. Complete this form to inquire about resources or request school health services from Huron Perth Public Health.

Request submitted by:

School:

Grade(s):

Number of students:

Email address:

Daytime phone number:

What is the preferred way to contact you?

What is your preferred time and day to be contacted?

What are you looking for, and by when? Please include subject area and type of resource or program (e.g. social skills small group programming, curriculum resources, whole school support, playground leaders training).

Your privacy

Any personal information or personal health information submitted on this form will be collected, used and disclosed by Huron Perth Public Health staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990 or the Personal Health Information Protection Act, 2004, S.O.2004, where applicable. Any information you share will be used only for the delivery of public health programs and services; de-identified information may be used for evaluation or statistical purposes. Questions about this collection of information should be directed to the Privacy Officer of Huron Perth Public Health by calling 1-888-221-2133 or emailing privacy@hpph.ca.

Access

Apply or Register

Report

Test

Form Builder

School Health Request Form

Your privacy