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Wheelchair Basketball Presentation Form
Wheelchair Basketball School Presentation Booking Form
If you are human, leave this field blank.
School Name
*
Educational Stage
*
Elementary School
Junior or Middle School
Secondary School
Other
Range of Grades in School
*
School District
*
Peel District School Board
Dufferin-Peel Catholic District School Board
Durham District School Board
Durham Catholic District School Board
Halton District School Board
Halton Catholic District School Board
Hamilton-Wentworth District School Board
Hamilton-Wentworth Catholic District School Board
Toronto District School Board
Toronto Catholic District School Board
York Region District School Board
York Catholic District School Board
Other
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.
*
9:30am to 10:30am
10:30am to 11:30am
11:30am to 12:30pm
12:30pm to 1:30pm
1:30pm to 2:30pm
Other
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
Submit
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