Arrive Alive Middle School Registration & Order Form
Please submit this form by 5:00p.m. on March 1, 2019 to ensure you receive campaign materials on time.
Our school will take part in the 2019 Arrive Alive Campaign by... *
Name of Middle School or Youth Group *
Your answer
School or Youth Group Address *
Please include city or town, state, and zip code
Your answer
School or Youth Group Telephone Number *
Your answer
Current Student Enrollment *
Your answer
Number of Students in Your Club or Youth Group *
Your answer
Adult Sponsor
This should be the individual assisting students with the campaign
Name *
Your answer
Telephone *
Your answer
Email *
Your answer
Campaign Materials
How many Arrive Alive posters would you like? *
How many Passenger/Pedestrian/Bike Bookmarks would you like? *
How many Arrive Alive Pledge Banners would you like? *
How many sunglasses with a safety message would you like? *
(Provided by the Allstate Foundation)
Adult Sponsor Agreement
I agree to abide by the rules of the Arrive Alive campaign and to adhere to all deadlines. *
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