SAFE Program Agreement Form Sponsor Contact Information Name Of School: County Name: SAFE Sponsor Name: School/Agency Name: Cell Phone Number (000-000-0000): Your Email Address: Shipping Information Please enter your shipping information in the fields provided below. Address: City: State: Zip Code (5 or 9 digits): Additional Contacts Contact #1 Name: Contact #1 School/Agency Name: Contact #1 Phone Number (000-000-0000): Contact #1 Email Address: Contact #2 Name: Contact #2 School/Agency Name: Contact #2 Phone Number (000-000-0000): Contact #2 Email Address: Additional Information Participating Building Student Body Population: Number Of Students On SAFE Team: Number Of Student Parking Lot Entrances: Do You Need Safety Vests? No Yes How Many Safety Vests Are Needed? Do You Need Pledge Cards? No Yes If an existing club adopted the SAFE program, please list their name (example: StuCo, NHS, FFA, FCCLA, KAY, FBLA, FCA): Please indicate what grades (middle and/or high school) will be part of the SAFE program in this building:
