Alameda County Safe Routes to Schools — Drive Your Bike Request Form

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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' Drive Your Bike program.

Drive Your Bike is an in-class bicycle safety training course for middle and high schools that emphasizes improving bike handling skills, educates students about the rules of the road and exposes students to safe biking routes to their schools. The middle school program is a 5-day in-class program, while the high school program is four days. Drive Your Bike can be scheduled Monday-Friday from September 2017 through June 2018.

Please fill out the form below to request a Drive Your Bike P. E. class at your school.

School Name *

School Address *

School District *

School Principal's Name *

School Principal's Main Contact Information

Please provide the best phone number or email address for your school's principal (if known).

Main School Contact's Name *

Please provide the name of the person who will help us schedule and coordinate this event at your school.

Main School Contact's Phone Number *

Main School Contact's Email Address *

What is the best way to communicate with the main school contact? *

Phone

In Person

Please provide at least three potential start dates for your school's Drive Your Bike P. E. program. *

Is there anything we should know about your bell schedule? *

i.e. short days on Wednesdays, block scheduling, etc.

Number of students in your largest class. *

Number of students interested in participating and their grade level(s). *

Is there a place at your school to store bikes during the program? *

Please describe. Note that we prefer an indoor space to store the bikes.

Please check the boxes next to the requirements to indicate that your school can provide them. *

School staff supervision to supervise each class

Minimum 50 x 100 sq. ft. blacktop or open space

Parent volunteers to chaperone field trips

Required

Does your school provide bike racks for student and staff use? *

Yes

Is your school enrolled in the Alameda County Safe Routes to School Program? *

Yes

Don't Know

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