Traffic Safety is a Team Sport
Name (First, Last Initial)
First Name
Last Initial
Choose Your Age Group
Under 16
16 - 18
19 - 21
21 - 30
31 - 65
66+
High School Grade (If Applicable)
9th Grade
10th Grade
11th Grade
12th Grade
N/A
School, Town, State
Example: Peoples Academy, Morristown, VT
Traffic Safety Pledge // Check All That Apply: "I am committed to the following..."
I promise to ALWAYS wear my seatbelt.
I promise to speak up when I am a passenger, making sure everyone in the car wears their seatbelt.
I understand that during my first three months of operation with a Junior Driver’s License, I must drive alone OR with at least one (1) front seat passenger who is a licensed and unimpaired parent or guardian OR driver education instructor OR individual 25 years of age or older. During my second three months of operation under a Junior Driver’s License, I may begin transporting family members. After holding a Junior Driver’s License for six months, there are not restrictions. However, I am never allowed to transport more passengers than there are safety belts.
I promise to turn off portable electronic devices and put them out of reach before starting to drive.
I promise to speak up when I am a passenger and my driver uses a portable electronic device while driving.
I understand that there are times when it’s OK to chase speed and adrenaline—but that time is not when we get behind the wheel and hit the road. When driving, I promise to take my time, and take care of others.
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