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Indiana SAFE KIDS Coalition Fact Sheets
National SAFE KIDS Campaign Fact Sheet

Bell Sports Bike Helmet Order Form - This order form should only be filled out by Chapters of the Indiana SAFE KIDS Coalition for bicycle safety presentations, activities, and events.

Chevy Venture Van Event Form - This is to be filled out at least 30 days after your Safe Kids Chapter/Coalition event. The Chevy Venture van must have been in attendance at your event.

Evenflo Child Passenger Safety Advocate Order form - To purchase child safety seats, including booster seats, from Evenflo.

First Alert Order Form - This form is to be used to order safety devices such as smoke detectors and carbon monoxide detectors through the National SAFE KIDS Campaign partner, First Alert.

GUNSAFE Discount Order Form - This form is to be used to order gun locks.

How to Organize a Walk to School Day event - This comprehensive list will give you information on how to organize a pedestrian safety project in your community.

Jello in a Jar Video - Order form for bicycle safety video.

Membership Application Form - This form is to be filled out by participating organizations and individuals of SAFE KIDS Chapters in Indiana.

Mercury Distributing Order Form - To order child safety seats of manufacturers like Nania, Cosco, and Graco.

NHTSA Class Document Literature from ASP - This is for the technician candidates folder.

NHTSA Class Flow Chart Safe Kids - This is for the technician candidates folder.

NHTSA Class Folder List

NHTSA Class Folders Recert Personal Log - This document is for instuctor's to place in technician candidates folder's.

NHTSA Class Recertification Flow Chart - This is for the technician candidates folder.

NHTSA Class Summary of Permanent Fitting Stations - This is for the technician candidates folder.

NHTSA Class Summary of Project LOVE - This is for the technician candidates folder.

Safe Kids Buckle Up Senior Instructor Profile - This form should be filled out for those Safe Kids chapter/coalition members that want to apply for Senior Checker profile status through the Safe Kids Buckle Up Program.

Safe Kids Car Seat Generic Check Up form - Please feel free to use this form when inspecting car seats on behalf of your program. This form should be filled out by certified child passenger safety technicians.

Safe Kids Indiana Chapter Statement of Agreement - This form must be filled out by new chapters that are established and affiliated with Safe Kids Indiana. This form should only be filled out after an introductory meeting between the interested county and the State Coalition Coordinator.

Safe Kids Indiana Fact Sheet - To learn more about Safe Kids Indiana, please read this document.

Safe Kids Indiana Mini Grant Program Report - This form should be filled out for all mini grant participants (excluding the $1000 traffic safety mini grant)conducting programs during Child Passenger Safety Week,Safe Kids Week, and other programs through the State Coalition.

Safe Kids Mini Grant Application - This is to be filled out by any Safe Kids Chapter or Coalition.

Safe Kids Mini Grant Evaluation - This evaluation should be filled out by September 30, 2006 for all Chapters receiving a $1000 traffic safety mini grant.

Safe Kids Program Proposal Form - Events and Projects specific to the State Coalition with Chapter Participation.

Seven Star Sports Order form - Order form for bike helmets

SKBU Car Seat Check Up Event Application.FY 06 - Application to apply for a car seat check up event sponsored by General Motors. Should be filled out at least 4 weeks prior to scheduled event. Grants for dealership events are worth $600. Grants for partner sponsored events are worth $400. This event needs to be conducted in partnership with a GM dealer, community partner, or as part of a registry

SKBU Car Seat Check Up Event Evaluation.FY 06 - Evaluation form for car seat check up events approved and funded by the Safe Kids Buckle Up Program.

SKBU CPS Awareness Workshop Application.FY 06 - Application needs to be filled out at least four weeks prior to scheduled workshop. Grant is worth $100. Attendees of workshop must be affiliated with a GM dealership, community-based organization, or retail establishment.

SKBU CPS Awareness Workshop Evaluation.FY 06 - Evaluation needs to be filled out within 30 days after event. Need to attach supporting documents such as evaluation form, original SAFE KIDS Buckle Up Checklist forms, and pictures/flyers.

SKBU NHTSA Class Application - This application should be filled out if your Safe Kids Chapter wants to host a NHTSA 32-hour Child Passenger Safety Class. The class must be registered online at www.safekids.org. This grant is worth $2000. Safe Kids Indiana has the right to approve or denial all or part of this grant.

SKBU Senior Checker Profile - Form to be filled out by SAFE KIDS members to become Senior Checkers through the National SAFE KIDS Buckle Up Program.

Spanish Waiver Form for Safe Kids Car Seat Checks - Please use this form when assisting bilingual families in your area.

WaterPals Safety Discount Order Form - This form is to be used to order PFD's (personal flotation devices).