Digital Program Request
Our Digital Program is done through pre-recorded videos and digital activities. This is a stand-alone curriculum that does not need Red Light Rebellion presenters in order to be conducted.

For additional details of how this works, check out page 38 of our Program Overview:
Sign in to Google to save your progress. Learn more
Brief Program Overview

Page 13 and 14 of our Program Overview fully explains each topic we cover and the length of each package:  

BASIC PACKAGE: Topics 1, 2 & 5
- Approximately two 50 minute lessons.

MOST POPULAR: Topics 1, 2, 4 & 5
- Approximately three 50 minute lessons.

FULL PROGRAM: Topics 1, 2, 4, & 5
- Approximately five 50 minute lessons.
Which classroom presentation are you registering for? *
Availability and bell schedules (standard, block, alternating, etc.) might impact which package you end up receiving. Pick your most ideal.
Personal Information
Name (first & last) *
Title/Position *
Grade (if student or teacher)
Email *
Phone Number (please put the number that is easiest to contact you) *
School Info
Name *
Address (Street, City, State, Zip Code) *
Website *
Bell Schedule *
The start and end time of each class period for your grade level and/or school.
Presentation Details
Note that it normally takes 5-10 minutes to log into the Digital Program and get students set up.
The class subject receiving the program: *
(Ex: health, history, language arts, media, criminal justice, etc.)
Are there additional teachers in your department that will be receiving the program as well? *
If yes, please provide their names and email addresses.
Each teacher receiving the Digital Program for their classes will receive a unique log in to access the Digital Program after everything is confirmed.
Requested date(s) for the Digital Program: *
Class periods that will receive the presentations: *
Specific time (ex: 1st-7th period with 3rd hour prep & 5th hour lunch). Do this for each teacher receiving the program.
Are there any known alternative schedules during presentation days? *
This can include: study hall days, assembly schedule, half days, fire alarms, lock down drills, etc.
If yes, please provide the dates and alternative schedule:
How many students will there be during each class period? *
Opt-out permission slips are available upon request. Would you like that to be provided by RLR? *
Additional comments:
Thank you for registering for our Digital Program! Here are some next steps you can expect after submitting this request:

-- -- If you would like to schedule a follow up meeting to ask questions or address the logistics of your request, feel free to schedule a meeting through the following link:
-- If you do not schedule a follow up meeting, we will contact you within a week of your submission to confirm your registration and begin the planning process.  
-- After all logistics are confirmed and dates are set, each teacher will receive a copyright protection waiver to sign digitally.
-- Once waivers are signed, we will email you a Digital Packet that includes all of the information you need to access the program.
-- If you requested an opt-out form, those will need to be sent home 1-2 weeks prior to the start of the program.

30 minute Zoom trainings on how to use the Digital Program (in addition to the PDF instructions included in your Digital Packet) are also available.

We are excited to fight for freedom with you. Welcome to the Rebellion!
Clear form
Never submit passwords through Google Forms.
This form was created inside of Red Light Rebellion. Report Abuse