Rainbow Injury Prevention Center

The Safe Kids Greater Cleveland Coalition relies on its partners to make a difference in the community. If you are conducting an activity, be sure to let us know all about it by submitting an Activity Report. The report is a short form, and allows us to show our funders all the great things going on in our community.

Fill out an Activity Report

 

Activity Report

1. Your Name*
2. Email**
3. Phone Number*
4. Name of Agency
5. Name of Event*
6. City*
7. Date*
8. Location*
9. Safety Topics
10. Bike/Helmet Child Passenger Safety DUI Fall Prevention Fire/Burn Prevention Firearms Home Safety Pedestrians Poison Prevention Seat Belts Traffic Safety Water Safety Youth Driving
11. Target Audience
12. Preschool Elementary School Junior High High School College Adults Senior Citizens
13. Type of Event Assembly Classroom Community Event Health Fair Meeting Presentation Other *
14. Attendance (estimate):*
15. How was Event Marketed?
16. Fliers TV Radio Print Media Website Other
17. Materials Used
18. Comments
19. Evaluation
20. Total Hours Committed to Project
21. Other Sponsors

 

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