Arrive Alive Registration & Order Form for Middle Schools
Please submit this form by 5:00p.m. on March 3, 2017 to ensure you receive campaign materials on time.
Our school will take part in the 2017 Arrive Alive Campaign by...
Name of Middle School
Your answer
School Address
Please include city or town, state, and zip code
Your answer
School Telephone Number
Your answer
Current School Enrollment
Your answer
Number of Students in Your Club
Your answer
School Resource Officer/ Sponsor
This should be the individual assisting students with the campaign
Your answer
Your answer
Your answer
Campaign Materials
How many Arrive Alive posters would you like?
How many Passenger/Bike/Pedestrian Tip Cards would you like?
How many Arrive Alive Pledge Banners would you like?
How many "Make Safety A Point" Pencils would you like?
(Provided by Mid-Atlantic Foundation for Safety and Education)
How many Sunglasses would you like?
(Provided by the Allstate Foundation)
Campaign Sponsor Agreement
I agree to abide by the rules of the Arrive Alive campaign and to adhere to all deadlines.
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