BLISS Kit Check out

Employee Information
Last Name
First Name
Employee ID#
Division
Email Address
Phone Number
Cell Phone
Fax

Checkout Information (Kits are available up to 24 hours in advance and must be returned the next business day)
Date of School Visit
Date of School Visit (Alternate #1)
Date of School Visit (Alternate #2)

School / Organization Information
School / Youth Organization
Teacher / Leader
School District
School Address
School Phone
Alternate Phone
Total Number in Group
Adults in Group
Students in Group
Grade Level

Choose a Kit
BLISS Kit Workshop Attended

Instructions / Guidelines

Requests must be submitted at least 14 business days prior to Checkout Date

BLISS Kits must be returned the next business day following Presentation Date

Inventory form must be completed and signed upon returning BLISS Kit

(510) 486-5511

Building 7, Room 220A
Supported by a generous gift from the S.D. Bechtel, Jr. Foundation