Pedestrian Rodeo/Pedestrian Safety Workshop Request Form - Alameda County Safe Routes to Schools

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The Alameda County Safe Routes to Schools Program is funded by the Alameda County Transportation Commission (www.alamedactc.org). Your transportation dollars at work!

Thanks for your interest in the Alameda County Safe Routes to Schools' Pedestrian Education Program. You can use this form to request a Safe Moves City Pedestrian Rodeo (outdoor activity) OR a Pedestrian Safety Workshop (indoor, assembly-style activity).

Please fill out the form below to request a Pedestrian Education class at your school.

Is your school enrolled in the Alameda County Safe Routes to Schools Program? *

Yes

No (If not, you must enroll your school in the program prior to requesting our activities. Visit http://alamedacountysr2s.org/our-program/register/ to enroll.)

I don't know

School Name *

School Address *

School District *

School Principal's Name *

School Principal's Main Contact Information *

Please provide the best phone number or email address for your school's principal (if known).

Main School Contact's Name *

Please provide the name of the person who will help us schedule and coordinate this event at your school.

Main School Contact's Phone Number *

Main School Contact's Email Address *

What is the best way to communicate with the main school contact? *

Phone

Other:

Please provide at least three (3) potential start dates for your school's Pedestrian Education program. *

Is there anything we should know about your school's bell schedule? *

i.e. short days on Wednesdays, block scheduling, etc.

How many students are in your largest class? *

Please list the number of students interested in participating and their grade levels. *

Please select the pedestrian education format you want to book. *

Please note, we can only book one format per school per school year.

Safe Moves City Pedestrian Rodeo (for a full description of this activity, please visit http://alamedacountysr2s.org/our-services/plan-an-event/pedestrian-rodeo/)

Pedestrian Safety Workshop (for a full description of this activity, please visit http://alamedacountysr2s.org/our-services/plan-an-event/pedestrian-safety-workshops/)

Please check the boxes next to the requirements below to indicate that your school can provide them. *

School staff supervision for each class

A minimum of 30 students (we work in groups of 30-35 students for 35 minutes per group)

Minimum 50 x 100 sq. ft. of available blacktop/playground/parking lot space or a multi-purpose room/auditorium/cafeteria

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms