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Request a Safe Routes Event

 
This page has been automatically translated from English. MSDH has not reviewed this translation and is not responsible for any inaccuracies.

Contact Information

 Name  
 Position  
 E-mail address  

E-mail is our primary means of contact; please provide an account that is frequently checked.

School Information

 School Name  
 City  
 State  
 Principal  
 Office Phone  

Performance Information

Safe Routes to School assemblies are tailored to the size of the audience. (Please be as accurate as possible; the materials provided are based on the number of participants given.)

Type of assembly requested  
Total number of students attending  
Type of assembly space   If Other, please specify:

Class room settings are preferred for Safe Routes events

Capacity of assembly space  
Preferred date   and time
Will you allow media coverage at this event?  Yes  No
 

Thank you for requesting a Safe Routes to School assembly at your school designed to elementary and middle school aged children pedestrian and bicycle safety. The Mississippi State Department of Health's Safe Routes to School office will contact you within one week of receipt of your application to schedule a program.

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Last reviewed on Jun 21, 2017
Mississippi State Department of Health 570 East Woodrow Wilson Dr Jackson, MS 39216 866-HLTHY4U web@HealthyMS.com
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