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2025-2026 Free Overdose Emergency Kit

Fill out form below to request:

Free Overdose Emergency Boxes to hold Naloxone in case of an emergency.
*Box only. Narcan not included.
1.School Name:(Required.)
2.School Address:(Required.)
3.Name of Person Completing Form:(Required.)
4.Email of Person Completing Form:(Required.)
5.Position of Person Completing Form:(Required.)
Please provide an estimate of the demographics of students benefiting from this program:
6.Provide an estimated percentage:(Required.)
7.Provide an estimated percentage:(Required.)
8.Age Group:(Required.)
9.Number of Boxes Requested:(Required.)
10.Please list the school location(s) each box will be assigned to within your school building:(Required.)
11.How did you hear about this offering?(Required.)
Thank you for your time to fill out this form. A Healthy Schools, Healthy Children Team will reach out to confirm your submission & coordinate delivery. If you have questions or wish to speak to a member of the team, please reach out by email: healthyschools@atlanticare.org.