1. Walking / Biking Clubs STEP 1 3 Easy Steps to Join Check the neighborhood map to find the route closest to your house! Fill out the “Walk / Bike Club Sign Up Form” and wait for your student leader to call you! MOVE it on Fridays! Walk or Bike to school every Friday ALL year! 2327 L Street, Sacramento, CA 95816-5014 (916) 440-1985 FAX (916) 440-1986 E-Mail info@capta.org www.capta.orginfo@capta.orgwww.capta.org _____________________________ has my (our) permission to participate in a Safe (Student Name) Routes to School Walk / Bike Club sponsored by the Coyote Ridge PTA for the school year 2009 to 2010. The undersigned parent or guardian assumes all risks in connection with the student’s participation in any and all of the PTA sponsored activities. I (we) hereby release and discharge the California State PTA, all PTA officers, employees and agents from all liability, claims or demands for any damage, loss or injury to the student, the student’s property, or parent’s property in connection with participation in these activities, unless caused by the negligence of the PTA. I do hereby certify that to the best of my (our) knowledge and belief said minor is in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood and agreed that the undersigned will assume full responsibility for any such action, including payment of costs. I (we) hereby advise that the above named minor has had the following allergies, medicine reactions or unusual physical condition which should be made known to a treating physician or which could limit participation: ________________________________________________________________________ Please write on above line. If none, write “NONE”. **DO NOT DETACH FORM. ENTIRE FORM MUST BE TURNED IN** ___________________________________________________________ Parent / Guardian #1 SignaturePrint NameDate _________________________________________________________ PhoneAddress – City – State – Zip ___________________________________________________________ Parent / Guardian #2 SignaturePrint NameDate _________________________________________________________ PhoneAddress – City – State – Zip 2009 - 2010 PARENT’S APPROVAL AND STUDENT WAIVER Get up & MOVE it! STEP 2 STEP 3 IMPORTANT DATES TO REMEMBER! JANUARY 14 – Club Sign Ups Begin! Tuesday, February 2 nd – Ice Cream Social & Family Safety Night Wednesday, February 3 rd – All School Safety Assembly Friday, February 5 th – 1 st Walk / Bike to School Day

2. What is the Safe Routes to School Program About? Many of you may have already heard about the National Safe Routes to School Program (a.k.a. SRTS). Here is a little history about how the program started and how it progressed from Europe to the United States. The term “Safe Routes to School” was developed due to a very successful initiative in Denmark in the 1970’s to reduce the number of child fatalities while walking/biking to school. It spread internationally to Europe, Australia, New Zealand, Canada and finally the United States. The National Center for Safe Routes to School Program (NCSRTS) was then launched in 1997 in the Bronx, NY. Within the next two years, many grassroots programs were launched all over the country. In 2005, the U.S. Congress officially established a National Safe Routes to School Program. Each state receives funds in the form of grants from the Federal Government. The City of Roseville is one of many cities in California to receive one of those grants to establish a SRTS Program. The grant funds have been awarded to the Dry Creek Elementary School District because of high enrollment and proven interest in this type of program (i.e. Walk to School Days, Fit Fridays). The schools included in the grant program are Coyote Ridge, Heritage Oak, Quail Glen Elementary Schools & Silverado Middle School. Coyote Ridge is the first school in our district to benefit from the grant! Joining a walking / biking club in your neighborhood is the first step toward participating in a world-wide initiative! PARENTS: Our goal is to have one parent on each route every Friday to walk with students – although we cannot guarantee a volunteer on every route. If you are interested in participating once per month, contact Shelby Renfeld at srenfeld@roseville.ca.us / renfeld4@comcast.net or 746-1376 / 772-3657.srenfeld@roseville.ca.usrenfeld4@comcast.net Here’s How to Join: Fill out the form to the right and sign the Parent Approval / Student Waiver on the reverse. Turn into your teacher as soon as possible! You will receive your “Backpack Club ID” via your classroom teacher. Your ID is your ticket into the Friday morning celebrations & prize drawings ALL year: EXCLUSIVELY for Club Members! ---------------------------------------------------------------------------------- I would like to sign up for the WEEKLY Walking / Biking Club sponsored by the. (Please PRINT clearly) Student Name __________________________ Teacher Name _____________ Room # ____ Phone ______________ Cell _____________ E-Mail _________________________________ Route Color (see map) ___________________ Emergency Contact ______________________ Phone ____________ Cell ____________ BikeWalk I am a parent & I would like to walk on Fridays! Please contact me! Name ________________________ Phone _____________________ E-Mail ___________________________________________________ DETACH HERE & RETURN TO TEACHER