Walk & 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.

I would like to receive the following materials in the mail

W2SD planning materials and stickers

In addition to Walk & Roll to School Day *

Please register me for the next Bike & Roll to School Day

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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