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REACH Monthly Challenge Form

Instructions

Complete a REACH Challenge this month! You can do a challenge on your own or include your kids, family and community members!
Fill out and submit a REACH form for each challenge you complete.
Have your name entered into the drawing for a chance to win a prize! (In order to have your name entered into the REACH drawing, you must fill out all information in the REACH form)
Increase your chances of winning a monthly prize, by completing up to 5 REACH Challenges!

Winners of the REACH Prize drawing will be announced at the end of the month.

Let's make this an East Aldine movement! Post to social media with the hashtag #EA_REACHChallenge

Name *

Which challenge did you complete? (E.g. attended a community meeting; attended a community fitness class; went for a walk outside with friends; cooked a meal using a new ingredient, etc.) *

Upload a photo of you completing the challenge. (JPG, PNG, GIF, max. 5MB) *

Choose File

By completing this form and uploading a photo, you give REACH the right to use the photograph(s) for educational or promotional publications and marketing materials (both digital and print) and for sharing with external media.

Would you like to be entered into the REACH drawing for a chance to win a prize? *

Yes

Phone

ZIP Code