Kindness Assembly Priority 1 Banner

Note: For Kindness Retreats (our full-day program, grades 4-5) click here for your Priority One form.
Note: For Kindness Concerts (grades 3-4) click here for your Priority One form.

Required fields are marked with *, please fill out all these fields before submitting. If you still experience problems, print out your completed Priority One Form and fax it to Youth Frontiers at 952.922.2122. If you have any questions, please call the Retreat Coordinator at 1.888.992.0222. Thank you--we are looking forward to working with your students!

*Required Information

School Information

School Name*

School Address*

City*

State*

Zip*

How many schools will participate in the assembly?
If more than one, please list the schools attending.

Contact Information

Note: The contact information entered should be for the person you would like Youth Frontiers to contact for assembly logistics (i.e., the person at your school who will be handling the details).

First Name*

Last Name*

Title*

Work Phone*

Fax*

Alternate Phone* (cell or home number)

Work E-Mail*

Second Contact Name

Second Contact Title

Second Contact Work Phone

Second Contact E-Mail Address

Kindness Assembly Information

Note: The program length for the Kindness Assembly is 50 minutes. The maximum number of participants per assembly is 200. If your school requires multiple assemblies, please enter the information for each assembly below.

Assembly Date*

Assembly 1 (Required)

    Times*

    Grade(s)*

    Number of Students*

Assembly 2

    Times

    Grade(s)

    Number of Students

Assembly 3

    Times

    Grade(s)

    Number of Students

Additional comments (if any)

In an effort to share our work with others, would you allow visitors to attend your retreat? (potential donors, principals, teachers, etc.)*

Yes No

Are you okay with media visiting to report on the retreat?*

Yes No

Will you allow Youth Frontiers to submit a press release regarding your retreat?*

Yes No

If so, please provide a short testimonial that can be included in the press release. (e.g. "Our school uses Youth Frontiers because...")

Kindness Assembly Location Information

Location Name*

Address*

City*

State*

Zip*

Phone*

Location Comments

(Optional) Enter anything our Retreat Staff should know about the location (best door to enter, detailed directions to, parking information, name of room or type of space, etc.)

Additional Information

Are there any school policies we should be aware of the day of the assembly? (e.g., cell phones, hats, iPods/earphones)
If yes, please explain.

Is there any additional information Youth Frontiers should know to best serve you?

What is the name of your community newspaper?

We appreciate your commitment to fund this program, and we'd like to use your wisdom to help other schools as well. How is your school funding this program? How could Youth Frontiers be a resource for your school in finding program funding?

How did you hear about Youth Frontiers?

Thank you for taking the time to complete the Priority One Form for your Kindness Assembly!

If you have any questions, please contact the Retreat Coordinator at 952.922.0433 or toll free 1.888.992.0222.

Submit your form by clicking the button below. Thank you!