PAGE / OF

School Name

(Please print and use
CAPITAL letters only)

School Address

(Please DO NOT use PO Boxes)

City

Zip-Code

/ --

County

Program Date

/ / / / / Start Time / End Time

M M D D Y Y Military Time Only Military Time Only

ALE Personnel:
(List first initial and last name of all ALE personnel involved in this program)
age / wITHOUTgoggles / wITH
GOGGLES / age / wITHOUT
gOGLES / WITH
GOGGLES
Driver 1 / Driver 13
Driver 2 / Driver 14
Driver 3 / Driver 15
Driver 4 / Driver 16
Driver 5 / Driver 17
Driver 6 / Driver 18
Driver 7 / Driver 19
Driver 8 / Driver 20
Driver 9 / Driver 21
Driver 1O / Driver 22
Driver 11 / Driver 23
Driver 12 / Driver 24
Narrative/Comments:
(weather conditions, etc)
AIC Signature /

Date

/ / / /

M M D D Y Y

Supervisor Signature / Date / / / /

m m d d y y

PAGE / OF

DRUNK BUSTERS ON WHEELS

age / wITHOUTgoggles / wITH
GOGGLES / age / wITHOUT
gOGLES / WITH
GOGGLES
Driver 25 / Driver 52
Driver 26 / Driver 53
Driver 27 / Driver 54
Driver 28 / Driver 55
Driver 29 / Driver 56
Driver 30 / Driver 57
Driver 31 / Driver 58
Driver 32 / Driver 59
Driver 33 / Driver 60
Driver 34 / Driver 61
Driver 35 / Driver 62
Driver 36 / Driver 63
Driver 37 / Driver 64
Driver 38 / Driver 65
Driver 39 / Driver 66
Driver 40 / Driver 67
Driver 41 / Driver 68
Driver 42 / Driver 69
Driver 43 / Driver 70
Driver 44 / Driver 71
Driver 45 / Driver 72
Driver 46 / Driver 73
Driver 47 / Driver 74
Driver 48 / Driver 75
Driver 49 / Driver 76
Driver 50 / Driver 77
Driver 51 / Driver 78