Schools Registration Form Survey

Your Name

Contact Number

E mail

Your Role

Region

Schools Details

Schools Details Name of School
Street
Suburb
Postcode
Number of Students

Your School (1)

Your School (2)

Your School (3)

Your School (4)

Does Your School Currently Have

Does Your School Currently Have Bicycle Education Activities

Adequate Bicycle Storage

Other Activities Promoting Active Transport

What are the specific barriers for students cycling (both to and from your school and in the wider community)?

What are the specific barriers for students cycling (both to and from your school and in the wider community)? School policy discourages or bans cycling

Lack of parking facilities

Concerns about traffic safety

Concerns about personal safety

Distance to far for a child to cycle

Lack of bicycle education

Parental concerns

Students do not own bicycles

Students carry heavy bags and equipment

Social pressure (students think cycling is uncool)

How did you hear about the schools program?

How did you hear about the schools program? Marketing material mailed to my school

Came across it while online

I received an email about the program

Word of mouth / Recommended by colleague

Through helmet design competition

Through 500km gold medal challenge

Newspaper

Other (please specify)

I give consent for my school to be registered and authorize Bicycle NSW to keep a record of the school details on file along with the Hands Up! survey information. I understand that my school may be used in the promotion of the program in promotional material (for which Bicycle NSW will seek the appropriate permission before hand).

I give consent for my school to be registered and authorize Bicycle NSW to keep a record of the school details on file along with the Hands Up! survey information. I understand that my school may be used in the promotion of the program in promotional material (for which Bicycle NSW will seek the appropriate permission before hand). I agree