This is a FREE Opportunity for your Child to Learn Behaviors that Promote Safety Applications: Available at the Oberlin Police Department, Eastwood Elementary School and The Oberlin Public Library Registration deadline: Friday, May 22, 2015 Eligibility: Children who will enter Kindergarten this fall Dates: EACH SAFETY TOWN SESSION/CLASS WILL LAST ONE WEEK THIS YEAR Session 1 is June 8-12th Monday-Friday Session 2 is June 15-19th Monday-Friday Class Times: Location: Morning Session 9:00 - 11:00 AM or Afternoon Session 1:00 — 3:00 PM Eastwood School Cafeteria 198 E. College Street, Oberlin Instructor: Lt. Kevin Scalli, Oberlin Police Dept. Questions: Lt. Kevin Scalli, Oberlin Police Department 774-1061 or at [email protected] Safety Town is sponsored by The Oberlin Exchange Club, Oberlin Police Department/City of Oberlin, Oberlin City Schools and many of our Oberlin merchants SAFETY TOWN REGISTRATION FORM June 2015 CHILD'S NAME: ____________________________________________DATE OF BIRTH:________________________ PARENT/GUARDIAN'S NAME: ______________________________________________________________________ ADDRESS: ______________________________________________________________________________________ HOME PHONE: _________________________________ WORK PHONE:________________________________ PERSON TO CONTACT IF PARENT/GUARDIAN CANNOT BE REACHED: NAME: _________________________________ RELATIONSHIP: _________________ PHONE: _________________ I would prefer that my child attend the (please check one Session and one Class type): _____Session #1 (June 8-12) ______Session #2 (June 15-19) _____ Morning class (9am-11am) _____ Afternoon class (1pm-3pm) ______Morning class (9am-11am) ______Afternoon class (1pm-3pm) Will your child be coming from the Oberlin Early Childhood Center? YES NO Does your child have any allergies (i.e., bee stings, food allergies, etc.)? YES NO If so, please list_______________________________________________________________________ THE DEADLINE FOR REGISTRATION IS FRIDAY, MAY 22, 2015 Please return this form to the Oberlin Police Department or the Eastwood School Secretary before May 22, 2015. Class size is limited, and registration is on a first-come, first-served basis. Any questions may be directed to Lt. Kevin Scalli, Oberlin Police Dept., 774-1061. You will be mailed more information after May 22, 2015. PERMISSION SLIP I give permission for my child, __________________________, to participate in Safety Town and it’s field trips, which may include; safety walks and school bus ride to/from Oberlin Splash Zone, with the understanding that neither the Oberlin Police Department, City of Oberlin, Oberlin Schools or the Oberlin Exchange Club is responsible for any accidents. _______________________________________ (Signature of parent/guardian) _____________________ (Date)
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