Time for Lyme- School Curriculum Order Form
A curriculum about tick-borne diseases for grades K, 3, 6 and 9 with age appropriate goals, activities and measurable guidelines. The curriculum includes tick awareness, prevention tips, proper tick removal, and the signs and symptoms of Lyme disease. The curriculum is designed for use in elementary school (grades K and 3), middle school (grade 6) and high school (grade 9). The K and 3rd grade programs focus on what ticks look like, where they live, and what to do if you find a tick with activities designed to ensure understanding of the program. The 6th grade program introduces more sophisticated concepts of prevention that is also delivered in a 22 minute DVD. The ninth grade program adds a discussion of the psychological, emotional and social ramifications of Lyme disease, best described in the words of the high school students through a 20-minute DVD, specifically designed to address this complex issue. Our hope is that education will prevent Lyme disease in those who are well, and promote empathy, understanding and compassion for those who are struggling to overcome their illness.
In addition to the curriculum (including the 6th and 9th grade DVD’s, the packet also includes:
I. Tick Removal Kit- A complete tick removal kit including fine point tweezers with attached magnifier in a travel case, designed in collaboration with the American Red Cross and the Greenwich Department of Health.
II. Nurses Information Packet- A general packet of information about Lyme disease symptoms as well as a protocol that can be used in schools to help identify students at risk for Lyme disease.
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ORDER FORM
TOTAL
I. School Curriculum Kit @ $60 each __________
II. Education Video _______Video(s) @ $12 each __________
III. Additional Tick Removal Kits ________Kit(s) @ $15 each __________
V. Tax-Deductible Donation for Lyme Disease Education & Research __________
TOTAL PAYMENT ENCLOSED __________
Please Print Delivery Address:
Name: __________________________________________________________________________________
Address: _________________________________________________________ _______________________
Phone Number: ________________________ May we add you to our mailing list? Yes___ _ No ____
Payment Method: Personal Check or Credit Card (Visa/Master Card /Amex Accepted)
My check for $________ is enclosed. (Please make check payable to Time For Lyme, Inc.)
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Authorized Signature
Time For Lyme, Inc.
(Affiliate of the Lyme Disease Association, Inc.)
A 501 (c) 3 Charitable Organization, Tax ID# 06-1559393
P.O. Box 31269, Greenwich, CT 06831
(203) 969-1333