Boomer Rides A Bus
(CD order form)

The information below will be used to monitor which school systems or Head Start programs
have ordered Boomer's CD Boomer Rides A Bus. The information requested is general
information. Rest assured, the information provided will not be shared or sold to any other entity.

YOUR NAME
JOB TITLE
SCHOOL SYSTEM or
HEAD START PROGRAM
STREET ADDRESS
CITY
STATE
ZIP CODE
BUSINESS PHONE NUMBER
E-MAIL
WHO PROVIDES THE
BUS SAFETY TRAINING
TO ELEMENTARY
STUDENTS IN YOUR
SCHOOL SYSTEM?
(1)TEACHERS
(2)BUS SAFETY TRAINERS
(3)TRANSPORTATION DIRECTOR
APPROXIMATE NUMBER OF
STUDENTS AGES 3-8 THAT
RIDE THE BUS IN YOUR
SYSTEM?
APPROXIMATE NUMBER OF
BUSES THAT SERVE YOUR
SYSTEM?
WOULD YOU BE INTERESTED
IN BOOMER COMING TO
YOUR SYSTEM TO VISIT?
COMMENTS OR REQUEST