Safe Routes to School Sign Up Form
Yes!  Our school wants to be part of the nationwide movement that aims to make it safer and easier for students to walk, bike, and roll to school. 
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Email *
First Name *
Last Name *
School Name *
School Street Address *
School town *
School zip code *
School county *
School Phone Number *
Number of students at your school *
Number of faculty/staff at your school *
Grades your school serves *
Percentage of students eligible for free/reduced lunch *
Are you your school's SRTS champion? *
What is your role at your school? *
School Champion Name *
If you are the "school champion", please write in your name again.
What is your School Champion's role at your school?
If it is you, skip this question
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Best way to contact School Champion *
Give us the email address/phone number/ etc that is the best way to contact the school champion (even if it's you)
What is your school's level of commitment to Safe Routes to School? *
What services from Local Motion are you interested in? *
What types of Safe Routes to School programming is your school able to commit to? *
What types of Safe Routes to School programming do you have concerns about your school being able to commit to? *
What are some goals for your school that you are hoping that SRTS can help you with? *
ex: getting students more active, air pollution from drop off and pick up, concerns about traffic flow/safety during drop off and pick up, making your school's routes easier and safer for students to choose to walk and bike, etc.
A copy of your responses will be emailed to the address you provided.
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