Culver City Safe Routes to School Parent/Caregiver/Student Pledge

Responsible Walking, Biking, and Driving
The Culver City Walk & Rollers asks parents, caregivers and students to support active transportation - walking and biking - to and from school as often as possible as part of the city-wide Safe Routes to School Program.

Walking and biking to school does not necessarily mean door-to-door or even everyday. Each block and every day not driven makes a difference in reducing traffic and pollution around our school sites while helping our children be more active, creating safer, healthier communities for our kids.

As a responsible parent / caregiver / student, I pledge to be a safety “Roll Model” and lead by example when walking, biking, rolling and driving around bicyclists and pedestrians and pledge to:
SUPPORT THE SAFE ROUTES TO SCHOOL PROGRAM by walking, biking, skating, scooting and carpooling to school more often and reinforce and explain safe behaviors around traffic.

STAY ALERT TO TRAFFIC USING MY EYES AND EARS by keeping my eyes on the road and not use my personal electronic equipment when walking, biking, rolling or driving in and around traffic in school zones.

• Crossing in crosswalks or at intersections;
• Stopping at the edge of the street & the outside edges of parked cars & look left, right, left again, & behind me, for traffic;
• Continuing to look for traffic in all directions as I’m crossing;
• Be attentive & courteous to crossing guards.


ALWAYS RIDE IN THE SAME DIRECTION AS TRAFFIC while bicycling on the road and yield to pedestrians when riding on the sidewalk (and only where it’s legal to do so).

BE EXTRA CAUTIOUS when walking, biking or rolling at night and in low-visibility conditions and I will use a flashlight or wear reflective gear or material on my clothes, shoes, backpack, helmet, and bike and use white front lights and red rear lights/reflectors on my bicycle as required by law.

• Keep my eyes on the road & not use electronic devices;
• Abide by the posted speed limit;
• Respect all stop signs & traffic signals, making complete stops & checking for pedestrians at all times;
• Watch for pedestrians as I exit my driveway, especially children as they are more difficult to see;
• Not make U-Turns in the school zone;
• Not double park to let my child(ren) enter or exit my vehicle;
• Only allow my child(ren) to enter and exit my car from the curb (passenger) side;
• Not idle my engine needlessly at school sites.

Parent/Caregiver Name *
Your answer
Child(ren)'s First Name(s)
Your answer
Email Address *
Your answer
Address *
Your answer
Phone Number *
Your answer
School *
Grade(s) *
Your answer
Teacher(s) *
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service