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.
* Required
Is your school enrolled in the Alameda County Safe Routes to Schools Program?
*
Yes
No (If not, you MUST enroll your school in the program prior to requesting our activities. Visit
http://alamedacountysr2s.org/our-program/register/
to enroll.)
Don't Know
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?
*
Email
Phone
Required
Please select the pedestrian education format you want to book.
*
Please note, we can only book one format per school per school year.
Safe Moves City Pedestrian Rodeo (for a full description of this activity, please visit
http://alamedacountysr2s.org/our-services/plan-an-event/pedestrian-rodeo/
)
Pedestrian Safety Workshop (for a full description of this activity, please visit
http://alamedacountysr2s.org/our-services/plan-an-event/pedestrian-safety-workshops/
)
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.
*
A minimum of 30 students (we work in groups of 30-35 students for 35 minutes per group)
School staff supervision
Available blacktop/playground/parking lot OR multi-purpose room/auditorium/cafeteria area of at least 100 x 50 feet
Required
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