Skip to content
Childhelp Speak Up Be Safe Information Request
Thank you for your interest in purchasing the Childhelp Speak Up Be Safe curriculum.
Please submit the following information to learn more and to receive a personalized quote.
*
First Name
(Required.)
*
Last Name
(Required.)
*
Title
(Required.)
Teacher
Administrator
Counselor
Social Worker
School Personnel
PTA Member
Board Member
Community Member
Other
*
Email Address
(Required.)
*
Phone Number
(Required.)
*
Name of School or Organization
(Required.)
School District, if applicable
*
Address
(Required.)
*
City
(Required.)
*
State/Region/Province
(Required.)
Zip
*
Please list the number of students at each grade level.
(Required.)
Pre-Kindergarten
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
How did you hear about us?
Conference or speaking event
Online Resource List
Social Media
Online Search
Referral - word of mouth
Previous or Existing User
Marketing Email
Other (please specify)