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 Use format xxx-xxx-xxxx 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 50 75 100 150 200 250 300 350 400 450 500 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. Delivery or Pickup I will pick up the passes Please deliver to my address provided above 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: Captcha Submit
