Register for Choose Love CONNECT 2021

Name*
First Last
Have you used Choose Love curriculum before?*
- Yes
- No
Which Choose Love program are you primarily interested in using?*
Don't worry, you'll have access to all of them - we'd just love to know which one brought you here today!
- For School
- Back-to-School (Brave New World Unit)
- For Home
- For Community (Book Club, special event, join the community, etc)
- For Champions
Where do you live?*
State / Province / Region ZIP / Postal Code Country
How did you hear about Choose Love?*
If a school, what is the full name of the school?
If an event, which event and location?
If other, please describe how you heard about us.
Choose Love School Programs
Since you are interested in one of our School programs, please tell us a little bit more about your school .... We understand that you might work *with* a school or possibly even numerous schools, so please just select one as a point of reference for the following questions.
Please tell us the city and state where your school is located?*
City State / Province / Region Country
School Name*
School Address*
Street Address City State / Province / Region ZIP / Postal Code Country
School Type*
School Role*
Please check all that apply.
- Home School Teacher
- Teacher
- Administrator
- Coach
- Counselor
- Librarian
- SEL Specialist
- Special Education
- Student
- Parent/Guardian
- Other
If other, please describe your school role.
What ages will you be using the curriculum for?*
Please check all that apply.
- Toddler (ages 0-3)
- Preschool (ages 3-4)
- Pre-K (ages 4-5)
- Kindergarten (ages 5-6)
- 1st Grade (ages 6-7)
- 2nd Grade (ages 7-8)
- 3rd Grade (ages 8-9)
- 4th Grade (ages 9-10)
- 5th Grade (ages 10-11)
- 6th Grade (ages 11-12)
- 7th Grade (ages 12-13)
- 8th Grade (ages 13-14)
- 9th Grade (ages 14-15)
- 10th Grade (ages 15-16)
- 11th Grade (ages 16-17)
- 12th Grade (ages 17-18)
- Adults (ages 18+)
How will you be using the curriculum?*
If other, please describe how you will use the curriculum.
How many students do you think you will reach with the curriculum?*
Choose Love for Work
Since you want to use Choose Love for Work, please tell us a bit more.
Workplace Name*
Workplace Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Workplace Role*
Please check all that apply.
- Manager
- Executive
- Human Resources
- Employee
- Owner
- Other
If other, please describe your workplace role.
How will you be using Choose Love for Work?*
If other, please describe how you will use Choose Love for Work.
How many people do you think you will reach with Choose Love for Work?*
Choose Love for Community
Since you want to use Choose Love for Community, please tell us a bit more.
Community Name, Organization or Initiative Name*

For example, "Bentonville Little League," "Norwalk Fire Station," "Citizen of Burlington," or "Governor's Office."
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Community Role
Please check all that apply.
- Manager
- Executive
- Member
- Other
If other, please describe your community role.
How will you be using Choose Love for Community?*
If other, please describe how you will use Choose Love for Community?
How many people do you think you will personally reach with the Choose Love for Community message and resources?*
Choose Love for Champions
Since you want to use Choose Love for Champions, please tell us a bit more.
Sports Organization/Initiative Name*
Sports Organization Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Sports Role*
Please check all that apply.
- Administrator
- Coach
- Athlete
- Other
If other, please describe your sports role.
What ages of athletes will you be using the curriculum for?*
Please check all that apply.
- Toddler (ages 0-3)
- Preschool (ages 3-4)
- Pre-K (ages 4-5)
- Kindergarten (ages 5-6)
- 1st Grade (ages 6-7)
- 2nd Grade (ages 7-8)
- 3rd Grade (ages 8-9)
- 4th Grade (ages 9-10)
- 5th Grade (ages 10-11)
- 6th Grade (ages 11-12)
- 7th Grade (ages 12-13)
- 8th Grade (ages 13-14)
- 9th Grade (ages 14-15)
- 10th Grade (ages 15-16)
- 11th Grade (ages 16-17)
- 12th Grade (ages 17-18)
- Adults (ages 18+)
How will you be using Choose Love for Champions?*
If other, please describe how you will use Choose Love for Champions.
How many people do you think you will reach with Choose Love for Champions?*
Choose Love for Military
Since you want to use Choose Love for Military, please tell us a bit more.
Military Organization/Initiative Name*
Military Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Military Role*
Please check all that apply.
- Active Duty
- Veteran
- Program Coordinator
- Family Member
- Other
If other, please describe your military role.
How will you be using Choose Love for Military?*
If other, please describe how you will use Choose Love for Military.
How many people do you think you will reach with Choose Love for Military?*
Create NEW Login
Even if your login information from our OTHER website is filled in below, you must still complete the registration form in full and submit it in order for your login to work on THIS website. If you experience any errors, please email us at [email protected] Thank you!
The CONNECT Community is for people ages 18 and older.*
- I confirm that I am at least 18 years old.
- I agree to represent the principles of Choosing Love in all community interactions.
Please note that our community promotes positivity, respect and kindness among all members. We will immediately suspend members who comment or otherwise behave in a manner inconsistent with the principles of The Jesse Lewis Choose Love Movement.
Personal Email*

(Please view our Privacy Policy -https://chooselovemovement.org/privacy-policy/- for reassurance that we will not share, sell or otherwise take advantage of your email address.)
Create A Username*
Password*
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Choose Love School Programs

Choose Love for Work

Choose Love for Community

Choose Love for Champions

Choose Love for Military

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THE STORY BEHIND THE MOVEMENT

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