Safe Kids USA will provide you with a 5 digit code after you register your rally. This code must be given to all parents and teens who attend your C2D Rally. The parents and teens will be required to enter the rally code when registering online.

Rally Information:

Facilitator Name:*

Facilitator Email:*

Rally Date:*

Start Time:*

End Time:*

Time Zone:*

Location:*

Street:*

City:*

State:*

Zip Code:*

Additional Information for posting on the Safe Kids USA Website:

Security Code:*