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Registration Form
Please provide the following information, so we may register your school in our system and begin providing you with technical support/materials. Note: When you submit the completed form, a confirmation page should appear. If the page appears blank, please scroll up to see the confirmation! Thank you!
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* Indicates required question
1. School Name:
Your answer
2. School City:
Your answer
3. School Zip Code:
Your answer
4. School District Name:
Your answer
5. IWalk/Roll Event Champion:
Our primary contact, the person who will coordinate your event.
Your answer
6. Phone number for Team Leader:
Your answer
7. Email address for Event Champion:
Your answer
8. Title of Event Champion:
e.g., parent, teacher, PTA president, principal, etc.
Your answer
9. Approximate school enrollment:
Your answer
10. School start time:
Your answer
11. School Principal Name:
If different than Event Champion.
Your answer
12. School Principal phone:
If different than Event Champion.
Your answer
13. School Principal email:
If different than Event Champion
Your answer
14. Did you participate in International Walk and Roll to School Day last year?
Yes
No
Clear selection
15. What date will you be celebrating your event?
*
We will celebrate on the Countywide Event date - Wednesday October 5th
We will celebrate on an alternative date (add "other" date below)
Other:
Required
16. Is your event part of an ongoing walking and/or bicycling encouragement program at your school?
For example, this event kicks off a year-long promotion, there are walk/bike days during the school year, and/or work is being done to improve safety such as sidewalk construction.
Yes
No
Clear selection
17. Please describe a few unique aspects of your event (such as activities, partners, strategies to make your inclusive, etc.).
Your description may be shared publicly. 500 character limit.
Your answer
18. How did you hear about Walk to School events?
Participated in the past
SRTS E-News
Walk to School website
Other:
Clear selection
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