Arrive Alive Materials Registration Form
Middle schools, high schools, and youth groups are encouraged to register for campaign materials to promote safe driving and passenger safety behaviors among youth and teens during the high-risk warm weather months.

High school materials will include a speed prevention and buckle up message.

Middle schools materials will include a buckle up message only.
Sign in to Google to save your progress. Learn more
Name of School or Youth Group: *
School or Youth Group Address Where You Would Like Materials Sent: *
School or Youth Group Telephone Number: *
Number of Students in Your Club or Youth Group: *
Number of Females in Your Club or Youth Group: *
Number of Males in Your Club or Youth Group: *
If a school, what is your school's current student enrollment? Youth groups may type N/A. *
Adult Sponsor First and Last Name: *
This should be the individual assisting students with the campaign.
Telephone Number: *
Email Address: *
How many posters would you like to order? *
How many Arrive Alive banners would you like to order? *
How many buckle up reminder cards would you like to order? *
These cards also include a QR code link to the Arrive Alive Summer Kit Registration Form. These kits are free to students ages 11-20. The high school cards also include a speed prevention message.
How many Arrive Alive Activity Books would you like to order? *
These Activity Books include word searches and puzzles, activity ideas, fun summer recipes, video resources, traffic safety tips, and more!
How many 'What to Do After a Crash' cards would you like to order? *
Middle schools may request these cards, but they are geared more toward high school students.
How many "The World Needs You. Buckle Up" stickers would you like to order? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms