Contact Person:
Email Address:
Phone Number:
School Name:
School Location (address):
Do you have disabled children in your school? YesNo
If yes, can you specify the types of disabilities?
Is your school public or private? PublicPrivate
How much space do you have available for a playground? (in m^2)
What playground equipment do you currently have?
Describe your school in 300 words or less:
Explain in 300 words or less why you are seeking funding for playground equipment:
Does your school employ a nurse or trained responders (EHBO)? YesNo
Is there a first aid station at your school? YesNo
What can your school contribute towards the financing or implementation of the playground equipment?
Will the playground be accessible to children outside of the school and/or outside school hours? YesNo
Select up to three options: Option AOption BOption COption DOption E
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