CCSD and Rocket team up for an  interactive presentation!
Please, fill out the form to schedule your presentation. 
Sign in to Google to save your progress. Learn more
Email *
School Name *
School Contact Name, Title, and Phone Number *
School Contact Email Address *
Grade Level *
Number of 20-minute Sessions on Presentation Day
* 50 students MAX per session 
 *
Total Number of Students *
Please list any additional information or accommodations needed in the classrooms: (e.g. special education, bilingual Spanish lesson, etc.)
Date Choice *
MM
/
DD
/
YYYY
Time Choice *
Time
:
ROCKETLive! is a SERIES of 3 Presentations at your school.  
When you submit a request, you will receive a confirmation of 3 consecutive dates within 48 hours.

 These are the ROCKETLive! Lessons that will be presented:
1. Safe Routes to School (Crossing the Street Safely and Bike Safety)
2. Safe People and Safe Places
3. Were You Kind Today? (Bullying Prevention)
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Rocketlive.

Does this form look suspicious? Report

Google Forms