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The Great Southern California ShakeOut
The Great Southern California ShakeOut

Agreement of Participation: Schools


The Earthquake Country Alliance is organizing The Great Southern California ShakeOut as a complement to this year's California "Golden Guardian" emergency management exercise by adding the participation of businesses, schools, and the general public. The main activity is the ShakeOut Drill on November 13, when millions of people will practice "Drop, Cover, and Hold On" and other safety steps.

Because most (K-12) schools are required to conduct earthquake drills every year, you are encouraged to participate in the Great Southern California ShakeOut. In submitting this document you are agreeing (at minimum) that your school or district will conduct an earthquake drill on November 13th and complete an after-action survey.

Other (optional) activities may include the promoting of earthquake preparedness lessons during the academic school year, and providing emergency preparedness information to parents/guardians. These and other resources for organizing your drill will be available at www.shakeout.org/schools.

Be a part of the largest earthquake drill in history!

Please complete this form to register your school, district, or related organization as a participant in the ShakeOut. Only items with an asterisk (*) are required.

Please select an option:*

  Yes!  We agree to participate, and I have authority to submit this
agreement on behalf of my school, district, or organization listed below.

  We are interested, however, we need more information and/or I do not have the authority
to submit this agreement on behalf of my school, district, or organization. Please contact me.
Contact Name:*  
Title:
Name of School, District or Organization:*
Please select:*
If a school, what type?:
Which grade levels does your school or district include?: Preschool   K   1   2   3   4   5   6   7   8
9   10   11   12   Adult   Post-secondary
County:*
District (if applicable):
Address:
City:*
State:
Zip Code:*
Country:
Phone:*
E-mail:*
(Enter same address twice to ensure it is correct.)
One valid email address only, please
School Website URL:
(Include "http../../")
Total number of schools sites participating:  (digits only -- no text, no ranges)
Total number of staff who will participate:*  (digits only -- no text, no ranges)
Total number of students who will participate:  (digits only -- no text, no ranges)
Comments:
My school is also an official participant in the Golden Guardian emergency response exercise:*  Yes
 No
Is it OK to list your organization on the ShakeOut.org website or other materials as a participant?*  Yes
 No
Is it OK to share your information with researchers who will study the effectiveness of the ShakeOut activities and may need to contact participants?*  Yes
 No

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