Wheelchair Basketball Presentation Form

School Name*

Educational Stage*

Range of Grades in School*

School District*

NOTE: We will be in the Peel/Halton regions from September to December and will visit all other districts from January to June.

Contact Name*

Position*

School Address*

City*

Postal Code*

Email*

Phone Number*

What is the total number of students at your school?*

How did you learn about our program?*

Do you have any students at your school that have a physical disability (i.e., multiple sclerosis, cerebral palsy, use a wheelchair or a walker, amputee, etc.)? *

Yes

No

Unsure

If yes, approximately how many students at your school have a physical disability?

Is your school wheelchair accessible?*

Yes

No

Please indicate at least 3 potential dates that work best for your school to schedule a presentation on.

Elementary and Middle schools can only choose Tuesday or Wednesdays Secondary schools can choose Monday, Tuesday, or Friday

Date Option 1*

Date Option 2*

Date Option 3*

Please indicate what time you would like to have your presentation. *

A Wheelchair Basketball Presentation will cost $400. How would you like to pay?*

Cheque

Credit

The cheque could be picked up by our team on your presentation date. The cheque should be made out to the ‘Ontario Para Network’. If need be, you could mail out the payment to us at: Ontario Para Network 100 Sunrise Avenue – Suite 101 Toronto, Ontario M4A 1B3

Wheelchair Basketball Presentation Form

Please indicate at least 3 potential dates that work best for your school to schedule a presentation on.

Upcoming Events