Reimagining Recess Pre-Program INTAKE

School/District Requesting Program

District

Contact Person Name

First Name

Last Name

Contact Person Position

Contact Person Email

Contact Person Cell Phone

(###)

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Date of Program

Name of School/Site Holding the Program

School/Site Address

Describe how recess is currently structured in your building(s)

Who will the participants be during the training?

Estimated number of participants

What are some goals/expectations for the participants during this training?

Reimagining Recess is 2.5 Hour Training. What is your desired start time for this training?

Anything our facilitators should know about the participants, facilities, or culture?