Jump School Registration 2021/2022

Please fill in the following:


*	First Name: Required
*	Last Name: Required
*	Email: Required
	Street 1:
	Street 2:
*	City: Required
*	Province / State: Required
	Postal / ZIP Code:
*	Phone Number: Required
	If you respond and have not already registered, you will receive periodic updates and communications from Heart and Stroke Foundation of Canada / Fondation des maladies du cœur et de lAVC du Canada.

Question - Not Required - Best time to call?

(Maximum response 1,000 characters)

*

Question - Required - School Name

(Maximum response 1,000 characters)

Question - Not Required - Principal's Name (First and Last)

Question - Not Required - Principal's Email

Question - Not Required - School Enrollment (#)

Question - Not Required - Approximate Event Day Date (if known)

Month

Day

Year

Question - Not Required - Approximate Digital Kick-Off Assembly Date (if known)

Month

Day

Year

Question - Not Required - Does your School allow student fundraising prizes?

Question - Not Required - Please add my email address to receive information related to Jump Rope for Heart.