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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.
Yes
No
Would you also be interested in a more intensive afterschool earn a bike program? (For schools with free and reduced lunch greater than 75%)
Yes
No
Which 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 person
How did you hear about Kids on Bikes?
Website
School
Friend
Word of Mouth
Attended other event
Additional information or comments
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