Skip to content

Registration Form for Schools/Colleges

Complete this form to register a K-12 public and private school, school district, pre-school, college, or university that will conduct an earthquake drill on October 20, 2011, involving the number of staff and students entered below. (This time is preferred, though you can hold your drill at another time or day if best for your schedule.) Information for how to plan your drill is available.

Only a simple "drop, cover, and hold on" drill is required, though you are encouraged to hold a more extensive test of your emergency plan.

If you give permission below, your organization will be listed with others on the school or college participant list page for your county.

ATTENTION

Past participants: If you registered your school or organization in a previous year, please login to register for 2011. (You will not need to enter everything again.)

You can request your access code for the login if you have forgotten it.

REGISTRATION FORM

Register on this page for the California ShakeOut. To register for another ShakeOut, select an area:
As a registered ShakeOut participant you will:
  • Be counted in the largest earthquake drill ever!
  • Be included on lists of who is participating in your area (optional)
  • Be an example that motivates others to participate and get prepared
  • Be updated with ShakeOut news and information about earthquakes and preparedness
  • Be provided a customized Certificate of Participation to download after the drill (when you register, be sure to list your name and organization as it should appear on the certificate)
  Yes!*   We will participate in the ShakeOut drill on October 20, 2011 (or another date within 2 weeks), and I have authority to register the school, district, or organization listed below.
Items marked by " * " are required.
Organization Information
Name of School, District or Organization:*
Organization type:*
Public/Private/Charter/etc:
Website:
(Include "http://")
County:*
District (if applicable):
Please include full name, such as "Johnson Valley Unified School District"
Which grade levels does your school or district include?: Preschool   K   1   2   3   4   5   6   7   8   9   10   11   12   Adult   Undergraduate   Graduate
Address:
City:*
State:
Zip Code:*
Country:
Total number of schools or 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)
School districts only: Do these participant numbers include your Charter Schools?
Describe your organization's plans
for participating in the ShakeOut
(you can update this later):
Is it OK to list your organization as a participant on the ShakeOut.org website or in other materials? *  Yes (Org. name, dept., district (if applicable), city, year(s) of participation)
 No
Is it OK to share your information with researchers studying the ShakeOut?*  Yes
 No
Contact Person
Contact Name:*  
Title:
Phone:*
Email:*
(Enter same address twice to ensure it is correct.)
One valid email address only (same in each box)
From which source(s) did you learn about the Great California ShakeOut?: ShakeOut / Earthquake Country Alliance
My employer
Another organization
My child or my child's school
Other friends or family
Facebook, Twitter, or blog
1-800-PREPARE.com
Television, radio, newspaper, or online news
Meeting or preparedness fair
Other:

Complete Your Registration:

NOTE: If you have a strict spam filter: Before submitting your registration, please allow emails from info@shakeout.org so you will receive our confirmation email. (Each email provider handles this differently.You may need to add info@shakeout.org to your email address list or to your spam filter "whitelist". Ask your IT staff if you don't know the procedure.)

Only click the button below ONCE. (If you have missed a required field, a note will appear. Enter the information and then click the button again.) If the form is complete, you should see a confirmation page, and receive a confirmation email within 10 minutes. If the email does not arrive, first look for it in your "spam" folder, then email info@shakeout.org for assistance.

© 2024 Statewide California Earthquake Center (SCEC), headquartered at the University of Southern California (USC)
Great ShakeOut Earthquake Drills