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Clean Air Challenge Patch Program
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Participation Form

& Steps To Earn
Clean Air Challenge Patch:

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Name of Participant:
Address:
Telephone Number:
1)? Read information on air pollution (call ALALAC at 1-800-LUNG-USA or (213) 935-5864?? for information);
2)? Discuss this information with your family or classmates;
3)? Decide on activity/activities which family or class will do to help clean the air;

I,?, pledge to complete the following activity for the Clean Air Challenge.

List activity planned.? Please be specific and include date(s) committed to activity.? The following are suggested activities;? you may select other clean air projects.? Choose activities you are not currently doing in support of clean air!

Start school-based recycling program (Recycle paper/aluminum cans.)
Date:		 Do a research project
(Examples in Smogbusters.)
Date:
Plant trees
(List how many planted.)
Date:		 Do a research project
(Examples in Smogbusters.)
Date:
Have parents car pool for a month
(Keep a log of car pool.)
Date:		 Reduce use of household aerosols
(List items.)
Date:
Plant trees
(List how many planted.)
Date:		 Recycle (paper/cans) for 1 month
(Report lbs.)
Date:
Have parents car pool for a month
(Keep a log of car pool.)
Date:		 Walk/bicycle/carpool to school
Date:
Start composting project
Date:
Other
4)? Complete activity (or activities) planned, print this form, fill it out,? and return it to the American Lung Association of Los Angeles County.? Please list all activities and describe accomplishments.
A).
?
B).
C).

5)I have completed all the requirements to earn the Clean Air Challenge patch.

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???????????? (Participant Signature) ????????????????????????????????????????????????????????????????? (Date)

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I affirm that the above child has completed all of the Clean Air Challenge requirements.

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????????????? (Parent/Teacher Signature) ???????????????????????????????????????????????????????? (Date)


Print this form, fill it out, and return it
to the American Lung Association of Los Angeles County:
5858 Wilshire Blvd. #300, L.A. CA 90036.?

The South Coast Air Quality Management District (AQMD)
generously supports this program.
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For more information, contact David Berger at:
1-800-LUNG-USA or (213) 935-5864 Ext. 232.

(Updated 2/2/98)

When You Can't Breathe, Nothing Else Matters ?
The mission of the American Lung Association of Los Angeles County
is to prevent and eliminate lung disease
and to improve the quality of life and health of those with lung disease.
Your contributions to Christmas Seals? and Chanukah Seals? help make the difference.

For more information on lung health, programs, and special events,
call ? ? (or ? ; ? ; ?1-800-LUNG-USA), ? or send us email.
? 1999 American Lung Association of Los Angeles County

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