PULSE café Junior High School Order Form

To arrange the resources for your students, please complete this form for the full school year.

"*" indicates required fields

Teacher's Name*

First Last

Teacher's Phone Number*

Teacher's Email Address*

Grade(s)*

Number of Classes*

Total Number of Students*

Name of School*

School's Mailing Address*

Street Address Address Line 2 City Province Postal Code

Teaching Notes (booklet)

Please enter a number from 0 to 1.

Student Activities Booklet

Please enter a number from 0 to 999.

Recipes with Nutrition Information (set of 11 recipes)

Please enter a number from 0 to 1.

Recipes without Nutrition Information (set of 11 recipes)

Please enter a number from 0 to 1.

Would you like to sign up for our quarterly Bright Ideas newsletter?*

Yes, please add me to your mailing list.

No, I don't want to receive any updates.

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