SCHOOL NAME

SCHOOL ADDRESS

TODAY’S DATE

Dear Parents and Guardians:

As part of our bicycle and pedestrian safety education, we will conduct several new activities on foot and bicycle in our Health and Fitness classes from PROGRAM START DATE to PROGRAM END DATE. The program will be led by INSTRUCTOR’S NAME, the POSITION with help from parents and community volunteers.

Bikes and helmets will be provided for your child to use. Students are not to bring their own bikes for the program. Students may bring their own helmets if clearly marked with first and last name.

You will be asked to take part in a homework survey that students should return to school.

Thank you,

INSTRUCTOR’S NAME

INSTRUCTORS POSITION

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

PLEASE RETURN THIS PERMISSION SLIP TO SCHOOL

My child, _______________________, may participate in the on- and off- campus lessons for the Bike and Pedestrian Safety Education Program. I hereby release the facilitators, state, school district, school, its employees, volunteers and any program participants from any and all liability with relationship to participation in the program.

Parent or guardian signature

Extra supervision is necessary to teach students to safely ride bikes. Bike experience is not necessary to volunteer.

Yes! I would like to volunteer for one or more of the lessons

Please check any dates you are able to volunteer on the list below, and return this form to the school. THANK YOU!

DATE AND TIME	Pedestrian Safety/Walking Audit

DATE AND TIME	Helmet Fitting and Bicycle Handling Skills

DATE AND TIME	Bicycle Handling Skills

DATE AND TIME	Bicycle Skills on Roads

DATE AND TIME	Bicycle Skills on Roads

Volunteer’s Name	Phone	Email