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, June 3rd, 2011

 

Eligibility: Children who will enter Kindergarten this fall

 

Dates:   EACH SAFETY TOWN SESSION/CLASS                                       WILL LAST ONE WEEK THIS YEAR  

           Session 1 is June 13-17 ^th  Monday-Friday

          Session 2 is June 20-24 ^th  Monday-Friday

       

Class Times:    Morning Session 9:00 - 11:00 AM                                              or

                  Afternoon Session 1:00 — 3:00 PM

 

Location:   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 police@oberlinpd.com

 

Safety Town is sponsored by The Oberlin Exchange Club, Oberlin Police Department, Oberlin City Schools   and many of our Oberlin merchants

 

 

SAFETY TOWN REGISTRATION FORM

June 2011

 

 

 

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 13-17)                         ______Session #2 (June 20-24)

 

                 _____ Morning class (9am-11am)                      ______Morning class (9am-11am)

                 _____ Afternoon class (1pm-3pm)                     ______Afternoon class (1pm-3pm)

                                                                                        

May we photograph your child during Safety Town for submission to our

sponsors and local newspapers?                                                                       YES       NO

 

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, JUNE 03, 2011

 

Please return this form to the Oberlin Police Department or the Eastwood School secretary

before June 03, 2011.  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 contacted to confirm your child’s enrollment session date and time.

 

 

 

 

PERMISSION SLIP

 

I give permission for my child, __________________________, to participate in Safety Town and

its field trips, which may include; safety walks and school bus ride to/from the Oberlin Fire Station,

with the understanding that neither the Oberlin Police Department, City of Oberlin, Oberlin Schools or             Oberlin Exchange Club is responsible for any accidents.

 

_______________________________________                _____________________

      (Signature of parent/guardian)                                                       (Date)