Title One Schools: Ditch Safety Pass Request Form

Applicant Information

Applicant Name   Please provide your full name; first and last

Applicant title/position at the school   Please provide your position at your school

School Name Please provide the name of your school

E-Mail Address  

Telephone Number

Street Address

City

State Use postal abbreviation.

Zip Code

Total Students

Number of Students   Provide total number of students at the school receiving swim passes

There is a limited amount of passes printed. Swim passes should go to someone in need of a free pool swim pass. Please provide passes to students who will take advantage of a free pool day this summer. If sending the passes home in the students backpack, please inform the parents of the free swim pass.

Quantity of Passes

Please provide a count of how many passes you will need for your school.

Total number of passes desired   There is a maximum of 500 per school. Please use your total number of students as a guide for calculating the amount of passes desired. Keep in mind, these are one time use passes.

50
75
100
150
200
250
300
350
400
450
500

Passes will be available for pickup on May 15, 2023.   Please pick up passes from the Parks and Recreation Admin office located at 1801 4th St NW - Building A, Albuquerque, NM 87102. If you are unable to pick up your requested passes we can mail them. Please indicate below:

I will pick up the passes

Please deliver to my address provided above