Take Action

Healthy Schools Act

Fill out the following form to have VIP submit your request to the school district, so you can receive notification of when, and what pesticides are used in the school your child(ren) attends or the school you may be employed in.

Download and fill out the form, including all schools or daycare centers where your children attend.

  • You may drop off or email your request to your school district office
  • You may also fill out our form and VIP will submit it for you

Your request must include:

  • Title: HSA-Request for Individual Pesticide Application
  • Your name
  • Method and details by which you would like to be notified:
    • email: you@gmail.com or
    • phone: 209-123-4567 or
    • USPS: Home address
  • The name of the school your child attends/ work location
Download Request Form
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