Prevention. Promotion. Protection.

Section Programs

Resources

NEW Kids Don't Float
PFD Loaner Program Application Form

Contact Person:

Sponsor Name:

Address (Include a Shipping Address for PFD's)

Work Phone:

Fax Number:

Email:

How Did You Hear About Us?

Comments:

 

Community Information

Do you have a Swim Education Program in your community? Yes   No If yes, where?
What is the population of your community?

If there is a Loaner Board in your community and where?
 

Site Information

(Enter up to four sites.  Submit this form again to add more sites.)

Site 1:

Description (Local Name)

City, Town, or Village Name:

Population:

Is there an existing Loaner Board at Site 1? Yes   No

Site 2:

Description (Local Name)

City, Town, or Village Name:

Population:

Is there an existing Loaner Board at Site 2? Yes   No

Site 3:

Description (Local Name)

City, Town, or Village Name:

Population:

Is there an existing Loaner Board at Site 3? Yes   No

Site 4:

Description (Local Name)

City, Town, or Village Name:

Population:

Is there an existing Loaner Board at Site 4? Yes   No
     

 

Number of PDF Sets:

(One set includes 2 infant, 4 child, 4 youth, 3 adult and 1 X-Large adult PFDs)

 

-OR-

 

Order by size:

Number of KDF Signs:

The sign is a 2 x 4 foot adhesive decal

Would you be interested in learning about the youth Peer Education program?

 Yes           No thank you
Would you be interested in classroom activities for teaching boating safety?

 Yes           No thank you
 
Additional Comments:

THANKS for your interest in promoting Kids Don't Float and making it a viable program in your community. Kids Don't Float is a statewide effort to reduce unintentional injury and drowning supported by the Alaska Department of Health and Social Services, the 17th Coast Guard District, the Alaska Boating Safety Program, and Alaska Safe Kids.

Click the "Send" button to submit information to the Kids Don't Float Office! Send email that pops up - or call Kids Don't Float if you have any difficulties submitting this form: (907) 465-4170