Safety Seminar Form Safety Seminar Request Form Complete this form and we’ll be in touch shortly Safety Seminar Request Form We would love to hear from you! Please fill out this form and we will get in touch with you shortly. Name*Name of School or Community Site*What are you interested in? Check all that apply* Helmet Safety Bike Safety Traffic Safety Other (describe in additional comments) What format do you want for the Safety Seminar? Check all that apply School-wide Assembly Classroom specific Afterschool Other (describe below in additional comments) Who requested that a Safety Seminar come to your site? Check all that apply You Parents Teachers Principals Students Seminars typically last 30 minutes to include helmet and bike safety. Do you have that amount of time available with kids.YesNoWould you also be interested in a more intensive afterschool earn a bike program? (For schools with free and reduced lunch greater than 75%)YesNoWhich grades would you like to attend the Safety Seminar? Check all that apply 3rd 4th 5th Other Who is the best person to follow up on this request with?*Contact email of above person* Contact phone of above personHow did you hear about Kids on Bikes? Website School Friend Word of Mouth Attended other event Additional information or comments This iframe contains the logic required to handle AJAX powered Gravity Forms.