Please print, then send or fax this form to: KIDS FROM KA-NA-TA RR #1 Thornbury, ON N0H 2P0 Fax: 519 599-5020 Phone: 519 599-7020.
Name of main teacher _________________________ Contact person (if different) ______________ Position ________________ Name of principal __________________ School board ___________________ School name ___________________ Purchase Order number ______________ Address ______________________________________ City __________________ Province ____ Postal code ___________ School phone (___)___________ Fax ____________ Home phone ______________ Where should we send your registration invoice ($279)? School __ Schoolboard __ Class Info: Grade level ____ Subject area ____ Number of students ____ Aboriginal Students ___ Have you done this project before or one like it? ___________________ Where did you hear about this program? ___________________
Many teachers like to log in to the project from home as well as from the classroom. This can be very helpful for keeping up with the online activity and being prepared when your students are ready to go.
Internet access: __ Class Modem __ School Network __ Home Computer System: __ Macintosh __ Windows E-mail address? _____________________
Are you interested applying for funding ($300) to cover program registration (we are still looking for sponsors to cover these costs as the GrassRoots program has been discontinued)? Yes ___ No ___
Are you interested in applying for a class exchange visit with a partner school? (Note:preference given to applications received by October 7, 2005) Yes ___ No ___
Teacher's Signature______________ Date ___________________ Principal's Agreement_____________________