Bike & Roll to School Day Registration

Contact Name *

Title

School Name *

Street Address *

(materials are shipped via UPS; please no P.O. boxes)

City *

County *

State *

Zip Code *

Email *

Phone Number *

How Many Students Will Be Involved? *

This is the number we use to determine the amount of materials to send to your school

Grades

Example: K-2, K-5, K-6, 6-8, etc.

Would you like to receive Bike & Roll to School Day stickers for your students? (Max of 200 per school. Due to current shipping logistics, registration after April 14 will be unable to receive BR2SD stickers).

Yes

No

In addition to Bike & Roll to School Day

Please register me for the next Walk & Roll to School Day (held in October)

Please send me more information on Safe Routes to School

Event Photography- I hereby grant Michigan Fitness Foundation the right to publish photographs from registered Michigan Safe Routes to School events for this School, such as Bike & Roll to School Day and/or Walk & Roll to School Day. *

Yes

No

Event Photography- I hereby confirm I have the authority to grant this permission to Michigan Fitness Foundation on behalf of this School. *

Yes

No

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