Registration & Order Form

Congratulations on becoming a champion for change by partnering with the Children's PowerPlay! Campaign. To get started, simply complete and return this form to your PowerPlay! Coordinator to receive your School Idea & Resource Kit and other materials.

Teacher Name:
School Name:
District Name:
School Address:
City/Zip:	County:
Phone:	Fax:
Email:

The best way to reach me is: Mail E-mail Phone Fax

I teach the following number of students: 4th Grade 5th Grade

Children's Power Play! Campaign Resources
	New Teacher Pack	Includes 1 School Idea & Resource Kit, 1 poster, 1 sample Kids...Get Cookin'! cookbook, 35 English-Language student workbooks, and 35 English-language parent brochures. Note: Spanish-language worksheets are available in the School Idea & Resource Kits.
	Returning Teacher Pack	If you still have your School Idea & Resource Kit (© 2005 or later), please order the Returning Teacher Pack. Includes 35 English-language student workbooks and 35 English-language parent brochures.
	Kids...Get Cookin'! Cookbooks	This kid-friendly English/Spanish cookbook featrues 20 tasty fruit and vegetable recipes. Note: Cookbooks are delivered after you have completed at least five activites and your Participation Report has been received by the Power Play! Campaign Coordinator.
packs of 10	Spanish-Language Parent Brochure	A Spanish-language version of the Campaign's parent brouchure. The brochure is available in packs of 10.

Please return Order Form to:
Michael Gieck Children's Power Play! Campaign Coordinator Network for a Healthy California- San Diego/Imperial Region UCSD School of Medicine Department of Pediatrics 4305 University Avenue, Suite 590 San Diego, California 92105 Ph: (619) 681-0659 Fax: (619) 681-0666 E-mail: mgieck@ucsd.edu

Funded by USDA'sFood Program through the California Department of Public Health.
These institutions are equal opportunity providers and employers.

Network for a Healthy California - Children's PowerPlay! Campaign San Diego/Imperial Region

4th & 5th Grade Teacher

Registration & Order Form

Network for a Healthy California - Children's PowerPlay! Campaign
San Diego/Imperial Region