Form Center

Request a Class

2. Directions
   The St. Charles County Department of Public Health offers a number of programs and services covering a wide range of health and wellness topics for children and adults. Please complete the form below to request an interactive class or community outreach program for your group.

   The St. Charles County Department of Public Health offers a number of programs and services covering a wide range of health and wellness topics for children and adults. Please complete the form below to request an interactive class or community outreach program for your group.

4. Name

5. Organization

7. Phone Number

8. Email

10. Address Line 1

12. Address Line 2

14. City

15. State

16. Zip

18. Age of Audience

    1. Preschool
    2. Elementary
    3. Middle School
    4. High School
    5. Adult
    6. Seniors

19. Requested Date of Event
    Requested Date of Event

    Requested Date of Event

21. Topic:

    1. Health and Nutrition
    2. Child Care Professionals
    3. Safety Certification
    4. Emergency Preparedness
    5. Environmental Health and Protection
    6. Community Outreach
    7. Pet Care

    Please mark all that you'd be interested in hosting.

23. Additional Programs
    If you are interested in programs or services on public health or emergency preparedness topics beyond the ones offered above, please call us at 636-949-7400.

    If you are interested in programs or services on public health or emergency preparedness topics beyond the ones offered above, please call us at 636-949-7400.

Leave This Blank:


24. Submit

* indicates a required field