SIGN A COMMITMENT FORM!

Organization:

Domain Category (please check one):
Business Childcare City and County Government Media and Marketing Schools
Community-Based Organization (Youth, Community or Faith) Healthcare Systems and Providers

Contact Name:
Title:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:
Web Page URL:


Statement of Support
My organization supports the Call to Action: San
Diego Childhood Obesity Action Plan and is committed
to preventing childhood obesity in San Diego County.
Yes

Strategy Implementation
Is your organization currently implementing strategies
for preventing childhood obesity?


If yes, what strategies is your organization currently implementing?


What new or recommended strategies will your organization commit to and implement?


With which other organizations within your domain and/or other domains will you coordinate efforts?


Who in your organization will work with the Childhood Obesity Initiative Director to
report and evaluate your efforts?

Contact Name:
Title:
Email Address:
Phone:
Thank You!