Agreement Form Complete this online agreement form and schedule SAFE training with the SAFE Program Specialist. Sponsor Contact Information Name of School *This field is required. County *Select...AdairAdamsAllamakeeAppanooseAudubonBentonBlack HawkBooneBremerBuchananBuena VistaButlerCalhounCarrollCassCedarCerro GordoCherokeeChickasawClarkeClayClaytonClintonCrawfordDallasDavisDecaturDelawareDes MoinesDickinsonDubuqueEmmetFayetteFloydFranklinFremontGreeneGrundyGuthrieHamiltonHancockHardinHarrisonHenryHowardHumboldtIdaIowaJacksonJasperJeffersonJohnsonJonesKeokukKossuthLeeLinnLouisaLucasLyonMadisonMahaskaMarionMarshallMillsMitchellMononaMonroeMontgomeryMuscatineO'BrienOsceolaPagePalo AltoPlymouthPocahontasPolkPottawattamiePoweshiekRinggoldSacScottShelbySiouxStoryTamaTaylorUnionVan BurenWapelloWarrenWashingtonWayneWebsterWinnebagoWinneshiekWoodburyWorthWrightThis field is required. First Name (SAFE Sponsor) *This field is required. Last Name (SAFE Sponsor) *This field is required. School/Agency Name *This field is required. Contact Number *This field is required. Email Address *This field is required. Shipping Information Address *This field is required. City *This field is required. State *Select...IowaThis field is required. Zip Code *This field is required. Additional Contacts Contact #1 NameThis field is required. Contact #1 School/Agency NameThis field is required. Contact #1 Phone NumberThis field is required. Contact #1 Email AddressThis field is required. Contact #2 NameThis field is required. Contact #2 School/Agency NameThis field is required. Contact #2 Phone NumberThis field is required. Contact #2 Email Address This field is required. Law Enforcement Contact NameThis field is required. Additional Information School Color(s) *This field is required. Official School Mascot *This field is required. Upload your school mascot logo (optional)This field is required.Accepted file types: JPG, GIF, PNG or PDF. Maximum file size: 10 MB. Participating Building Student Body Population *This field is required. Number of Students on SAFE Team *This field is required. Number of Student Parking Lot Entrances *This field is required. Do you need Safety Vests? *Select...YesNoThis field is required. Do you need Pledge Cards? *Select...YesNoThis field is required. How many Pledge Cards do you have remaining? *This field is required. If an existing club adopted the SAFE program, please list their name (Example: StuCo, NHS, FFA, FCCLA, KAY, FBLA, FCA, etc.) *This field is required. Please indicate what grades (middle and/or high school) will be part of the SAFE program in this building. *This field is required. Submit