Chalk It Up!

Entry Form

Chalk-It-Up: What Does a Healthy Relationship Look Like?

Wednesday, April 26th at Aptos Campus
Thursday, April 27th at Watsonville Center

9am-2pm

Name(s):_______________________________________________________________________________

Address:_______________________________________________________________________________

Phone: _________________________

Email Address:_________________________________________________________________________

Category (check one)

______ Cabrillo Student ______ Cabrillo Student Organization

______ Community Member ______Community Organization

I have read the Cabrillo Chalk-It-Up entry guidelines, and agree to all the terms and conditions:

Signature__________________________________ Date________________________

Sponsored by Cabrillo College Student Health Center
E-mail: maorr@cabrillo.edu
Website: http://www.cabrillo.edu/services/health/

PLEASE Return this entry form to

Student Health Services, Rm 912
Cabrillo College
6500 Soquel Drive
Aptos, CA 95003

OR Student Resource Center
Cabrillo College Watsonville Center
318 Union Street
Watsonville, CA 95076