We are dedicated to encouraging teens to make better choices concerning their health, safety, and future by providing educational programs that speak to the life changing effects of drug use, underage drinking and driving.

Impact 2010 School Survey
School Name
Approximate number of juniors & seniors attending
Number of chaperones attending
(schools that have students at Tri-County do NOT put those students in your count)
Is this event a mandatory field trip for your schoolYes:      No:
Approximate number of buses arriving
Transportation Director
Name
Email
Phone
Cell
School Mascot
Does your district have a school mascot?Yes:      No:
If no, can you make, purchase or have one available for the event?Yes:      No:
What is your school mascot?
School colors
Can you bring the costume & a student to be the mascot?Yes:      No:
(We will have a special mascot challenge at IMPACT 2010. More details to come).
Arrival/Departure Details:
Can you arrive at the Convo by 10:00 am on Friday, April 9th, 2010?Yes:      No:
If no, please state the earliest time you can arrive
Please let me know the latest time your students can arrive back to your school:
Your District’s contact person for this event:
Name
Title
Email
Phone
Cell
Other Info
Back-up contact person:
Name
Title
Email
Phone
Cell
Other Info