Safety Town 2025 Registration

Safety Town Classes Available

Please select the Safety Town class you would like your child to attend

Child's Name (MUST BE ENTERING KINDERGARTEN FOR THE 2025-2026 SCHOOL YEAR)

First Name

Last Name

Child's Date of Birth

YYYY

Child's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent / Guardian Name

First Name

Last Name

Parent / Guardian Phone

(###)

###

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Parent / Guardian Email

Child's Dr. Name

First Name

Last Name

Child's Dr. Phone

(###)

###

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Emergency Contact #1 Name

First Name

Last Name

Emergency Contact #1 Phone

(###)

###

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Emergency Contact #2 Name

First Name

Last Name

Emergency Contact #2 Phone

(###)

###

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