Alameda County Safe Routes to Schools — Pedestrian Education Request Form
The Alameda County Safe Routes to Schools Program is funded by the Alameda County Transportation Commission (www.alamedactc.org). Your transportation dollars at work!

Thanks for your interest in the Alameda County Safe Routes to Schools' Pedestrian Education Program. You can use this form to request a Safe Moves City Pedestrian Rodeo (outdoors activity) OR a Pedestrian Safety Workshop (indoors, assembly-style activity).

Please fill out the form below.
Is your school enrolled in the Alameda County Safe Routes to Schools Program? *
School Name *
Your answer
School Address *
Your answer
School District *
Your answer
School Principal's Name *
Your answer
Main School Contact's Name *
Please provide the name of the person who will help us schedule and coordinate this event at your school.
Your answer
Main School Contact's Phone Number *
Your answer
Main School Contact's Email Address *
Your answer
What is the best way to communicate with the main school contact? *
Required
Please select the pedestrian education format you want to book. *
Please note, we can only book one format per school per school year.
Please enter your top three (3) preferred dates for booking your event. *
Your answer
Please check the boxes next to the requirements below to indicate that your school can provide them. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms