School Bookings

Use this form to submit a request for Dr YES (Youth Education Sessions) to visit your school.

School Details

School:
Contact Person:
Address:
Phone Number:
Fax Number:
Email Address:
Spam Prevention:	What is this? By copying the text in the box above you are showing you are a person, not an automated "bot" designed to send spam.

Please provide details of the class you would like us to visit. Please be as accurate as possible. We realise that exact class times and days are not known until closer to the date. You can provide up to 3 preferences below.

Preference 1

Preference 2

Preference 3

Please ensure all above information is correct prior to submitting.

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Year:	10 11 12
Term:	1st 2nd 3rd 4th
Number of Students:	(min 30)
Number of Sessions:
Topics:	Sexual Health Alcohol & Other Drugs Mental Health
Day(s):	Mon Tue Wed Thu Fri

Year:	10 11 12
Term:	1st 2nd 3rd 4th
Number of Students:	(min 30)
Number of Sessions:
Topics:	Sexual Health Alcohol & Other Drugs Mental Health
Day(s):	Mon Tue Wed Thu Fri

Year:	10 11 12
Term:	1st 2nd 3rd 4th
Number of Students:	(min 30)
Number of Sessions:
Topics:	Sexual Health Alcohol & Other Drugs Mental Health
Day(s):	Mon Tue Wed Thu Fri