Clearcreek Township Safety Town 2026 Registration

SAFETY TOWN 2026 REGISTRATION
Parent/Guardian Info
Parent/Guardian Name*

First NameLast Name
E-mail*
Primary Phone*

Area CodePhone Number
Work or secondary Phone

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact (If Parent/Guardian cannot be reached)*
Relationship to Student*
Emergency Phone*

Area CodePhone Number
Alternate Individual Permitted to pick up child (must show valid ID at pickup)

First NameLast Name
Alternate Individual Permitted to pick up child (must show valid ID at pickup)

First NameLast Name
Alternate Individual Permitted to pick up child (must show valid ID at pickup)

First NameLast Name
Alternate Individual Permitted to pick up child (must show valid ID at pickup)

First NameLast Name
Student Info
Student Name*

First NameLast Name
Age*
Birthdate*

MonthDayYear (four digit)
MaleFemale
Please list any allergies or medical conditions we should be aware of
Medical
Physician Name*
Physician Phone Number*

Area CodePhone Number
YesNo
I give consent to the Clearcreek Township Police Department and/or the City of Springboro Police Department to use digital photographs of my child in print and other media including the Clearcreek Township Police Department and/or the City of Springboro Police Department website or Facebook page, exclusively for promotion of the Clearcreek Township Police Department and/or City of Springboro Police Department programs.*

YesNo
Youth SmallYouth MediumYouth LargeYouth X-Large
Notes:
YesNo
Please choose from the following class times. Once a class has reached full capacity, you will no longer be able to choose that session. Next to each class, you will see how many spots are still available.
Safety Town Plus Information:

Clearcreek Township Police Department and Springboro Police Department are offering an abridged version of Safety Town for students with significant developmental disabilities. If you have a child with a developmental disability who may be unable to tolerate the length and content of the traditional Safety Town curriculum, Safety Town Plus may be an option for you! Safety Town Plus will offer a sensory friendly environment with a modified curriculum to address prioritized safety skills and information. Please contact Officer Schrage at jschrage@clearcreektownship.com to arrange class sessions based on your child's needs. This program will be offered on a first-come, first-serve basis with a limit of 20 applicants. If you feel this option would be an appropriate fit for your child, please select Safety Town Plus in the class options above.
Terms and Conditions
Today's Date

MonthDayYear
Date
I hereby release and hold harmless Clearcreek Township and the City of Springboro and all of its employees, agents, volunteers and representatives from any and all claims, costs, damages and liabilities for any injuries sustained by my minor child’s participation in Safety Town. I understand that this program does not include accident or personal property insurance. I further represent that my child is physically capable of participating in the program in which my child is enrolled.
I AgreeI Do not agree
Signature*

***** Please read these important instructions

for class procedures******

This information will also be emailed to you so that you can print for reference.

Classes are held at the Five Points Elementary School at 650 E Lytle 5 Points Road. Please enter the door on the southeast corner of the building near the playground. We ask that your child arrive 15 minutes prior to start of class to sign in. Officers will begin class PROMPTLY. You will receive an email confirmation of your registration and an email reminder 6-7 days prior to your child’s class. When picking up your child, you will need to show valid ID (i.e., driver’s license) prior to your child’s release. If someone else (i.e., babysitter, grandparent, carpooler, etc.) will be picking up your child, they will also need to show a valid ID. Please be sure to let that person know. To ensure the safety of your child, no child will be released to anyone without valid ID. We ask that you please list those you would like to designate to drop off/pick up your child so we can have them listed on the sign in/sign out sheets prior to class.

We ask that your son or daughter wear gym shoes (no flip-flops or sandals) and girls please wear shorts or pants (no dresses or skirts) as they will be pedaling cars.

If your child needs to carry an Epi Pen, please make sure they are carrying it at all times during class since we will not be in one location at all times. Place in a fanny pouch if possible that is marked with their name. This will also avoid the Epi Pen getting left behind in the school building after it has been closed for the evening.

Downloadable, class activity sheets will be available online.

Friday is graduation day! Parents are encouraged to join graduation, we will go over everything the children learned during the week and have a brief ceremony. You will notified of the time for your child's color group.

If you have any additional questions feel free to contact us at

(937)748-1267 FROM 8am—4pm, MON—FRI and we will be happy to answer them for you.
Should be Empty:

Parent/Guardian Info

Student Info

Terms and Conditions