International Walk & Roll to School Day Registration, Sonoma County Safe Routes to School Program

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Please provide the following information, so we may count your school and provide you with promotional materials and technical support if needed. Note: When you submit the completed form, a confirmation page should appear. If the page appears blank, please scroll up to see the confirmation! Thank you!

1. School Name *

2. School City *

3. IWalk/Roll Event Champion (Our primary contact, the person who will coordinate your event) *

4. IWalk/Roll Champion email address *

5. IWalk/Roll Champion Phone number (mobile preferred) *

6. IWalkl/Roll Champion Title (ie.g., parent, teacher, PTA president, principal, etc.) *

7. Approximate School Enrollment *

8. School Start Time *

Time

9. School Principal Name (if same as event champion, write "same") *

10. What Date will you be celebrating your event? *

Wednesday October 9th (official date of International Walk & Roll to School Day)

We will celebrate on an alternative date (add date below in "other" field)

Other:

Required

11. How many promotional items (color-changing mood pencils, walk/roll day stickers, and posters) would you like to request? Please indicate your desired number for pencils, stickers and 11x17 posters. Let us know if you do not want any of a particular item. *

14. Please describe a few unique aspects of your event (such as activities, strategies to make your event inclusive, meet up spots, etc.). *

15. If you are not already enrolled in the in the Sonoma County Safe Routes to School Program for the 2024-25 school year, would you like to enroll? Enrolling provides eligibility to receive SRTS education services such virtual or in-person bicycle/pedestrian safety education and more. If you indicate yes, we will contact you re: services we are able to provide this year. *

yes, please enroll me in the program.

no, I would just like to participate in International Walk & Roll to School Day at this time.

I am already enrolled in the SRTS program for 2024-25.

Other:

16. How did you hear about the International Walk and Roll to School Day event? *

17. Do you have any additional questions?

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