SCHOOL SAFETY PATROL ORDER FORM

AAA School Safety Patrol Order Form

School Information

School Name

Contact/Patrol Supervisor First Name

Contact/Patrol Supervisor Last Name

Street Address (No PO Boxes)

Address

City/Town

State

- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

Telephone

Fax

Email Address

Number of Safety Patrollers

Number of Students in School

If you have any questions, please email safetypatrol@nyaaa.com or call (585) 388-4040 or (716) 929-3600.

Materials Needed

Safety Patrol Belt

We will replace worn/damaged belts or provide additional belts for new and expanding patrol programs. However, large quantities above and beyond normal replacements and additions will be at cost, approx. $5 per belt.

Safety Patrol Belt Details

Regular Size Quantity

Large Size Quantity

X-large Size Quantity

Application for Membership

1 per patrol person, includes parent consent and perforated membership card

Application for Membership Details

Application Quantity

Member Handbook

1 per patrol person

Member Handbook Details

Member Handbook Quantity

Award of Merit

End of year certificate – 1 per patrol person (available only as a PDF)

Award of Merit Details

Award of Merit Quantity

Captain's Badge

Every school patrol should have a Captain who possesses strong leadership

Captain's Badge Details

Captain's Badge Quantity

Lieutenant's Badge

Every patrol should have one or more Lieutenants, one of which becomes acting Captain in the former’s absence

Lieutenant's Badge Details

Lieutenant's Badge Quantity

Patrolman's Badge

For other patrol persons

Patrolman's Badge Details

Patrolman's Badge Quantity

Patrolman Service Pin

Year end – 1 per patrol person (Please note: Captain and Lieutenant pins not available. Patrolman pins can be used for all patrollers.)

Patrolman Service Pin Details

Patrolman Service Pin Quantity

Note: Belts and badges should remain the property of the school. Awards of merit and service pins can be given as end-of-year keepsakes.

Submit

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