2025-2026 Student Wellness Challenge Request Form

Please complete the form below to submit your request for any of our student wellness challenges.

For each activity, share a short summary after the final week via email to healthyschools@atlanticare.org

For walking challenge, completed logs are due no later than 2 weeks after the challenge end date in order to deliver student prizes.

Deadline for requests: May 1, 2026

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* 1. School Name:

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* 2. School Mailing Address:

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* 3. Name of Person Submitting Form:

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* 4. Email of Person Submitting Form:

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* 5. Alternate Contact Name:

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* 6. Alternate Contact Email:

Please provide an estimate of the demographics of students participating in the activity:

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* 7. Provide an estimated percentage:

Male

Female

Other

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* 8. Provide an estimated percentage:

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Another race

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* 9. Age Group:

5-9

10-13

14-18

18+

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* 10. Select the student challenge(s) you would like to participate in:
*eligible for 1 of each per school per year

Student Monthly Fun Runs - Each month host a themed mile run event, either during or outside regular P.E. classes, where students can earn monthly certificates upon completion.
Minimum 2 classes must participate per event. Schools will receive monthly themed student certificate templates for October through May. Schools will receive a starter kit with 8 water bottles to use as incentives or prizes for students.

Student Mileage Club - Outside regular P.E. classes, organize ongoing student mile runs or walks. Students can earn toe tokens upon each mile completion. Minimum 10 students must participate. Mile runs or walks must be held outside of regular P.E. classes. Mile runs or walks can take place during recess. Club can be before or after school. Schools will receive a starter kit that includes a bag of toe tokens to give out to students, plus 10 water pouches to use as incentives or prizes. Pedometers available upon request.

Mindfulness Kit - Assortment of age-appropriate items to promote healthy stress management such as journals and fidgets.

Pack-a-Snack Kit- Pack-a-Snack is an easy-to-implement, incentive-based program that helps young people discover healthy diet habits and choose healthy snacks. Snack time is a common childhood staple in elementary classrooms. It can be an opportunity for a much-needed brain boost. Or it can turn out to be a blast of processed sugars, disruptive to any classroom. Each kit includes Step-by-Step Instructions, Recording Sheet, & Reproducible Parent Letter (with a Healthy Snacks List) to send home with students to get parents on board with the program, Incredible Edible Snacks™ Poster, Wise Size Poster, 25 Snack Cards 150 Nutrition Charm Awards, and 25 MyPlate Good Eating Cards.

Pedometers - Set of 30 pedometers for students to track steps during classroom or P.E. challenges.

Walking Challenge - This 4-week program is open to classes in grades K-12. A minimum of 3 classes per school must participate to earn points and prizes in conjunction with AtlantiCare's Turn Your School Wellness Into Wealth Program. Record the daily and weekly classroom minutes walked on the log which is located on the reverse side and submit to healthyschools@atlanticare.org. Classroom minutes are not to be combined. Each individual class will be awarded based on number of minutes walked.

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* 11. If you requested the 4-week walking challenge, what is the tentative date it will start?

Start Date

Date

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* 12. If you requested the 4-week walking challenge, what is the tentative date it will end?

End Date

Date

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* 13. What days/times are best to drop off supplies to your school?
*if applicable

Once request is received, a Healthy Schools Team member will confirm receipt within 72 hours. If you do not receive a confirmation, please email a team member at healthyschools@atlanticare.org.

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* 1. School Name:

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* 2. School Mailing Address:

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* 3. Name of Person Submitting Form:

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* 4. Email of Person Submitting Form:

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* 5. Alternate Contact Name:

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* 6. Alternate Contact Email:

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* 7. Provide an estimated percentage:

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* 8. Provide an estimated percentage:

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* 9. Age Group:

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* 10. Select the student challenge(s) you would like to participate in:*eligible for 1 of each per school per year

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* 11. If you requested the 4-week walking challenge, what is the tentative date it will start?

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* 12. If you requested the 4-week walking challenge, what is the tentative date it will end?

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* 13. What days/times are best to drop off supplies to your school?*if applicable

* 10. Select the student challenge(s) you would like to participate in:
*eligible for 1 of each per school per year

* 13. What days/times are best to drop off supplies to your school?
*if applicable