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Republic Services Safe Driver Pledge Form 2022


Distracted driving kills and injures thousands of people each year. Make the commitment to not drive distracted in any way, and make it home safe at the end of the day.

I pledge to:

  • Protect lives by not driving distracted in any way.
  • Speak out if the driver in my vehicle is distracted.
  • Encourage my friends and family to join me in taking the Safe Driver Pledge.


First Name

Last Name

Email Address




Bounce back message:

Thank you for your commitment to end distracted driving. Please encourage your loved ones, especially teen drivers, to join you in taking the Safe Driver Pledge.