Safety Village Registration 2025

Safety Village Registration 2025
Monday, June 23rd - Thursday June 26th
9:30am - 12:00pm

Child's Name*

First NameLast Name

Parent/Guardian #1*

First NameLast Name

Parent/Guardian #2

First NameLast Name

E-mail (all communication will be sent via email)*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell phone number will be used for teaching purposes.

Home Phone Number

Area CodePhone Number

Cell Phone Number*

Area CodePhone Number

Please Choose t-Shirt Size for your Child*

Youth XSYouth SYouth MYouth L

How did you hear about the program?

Preschool currently attending, if any*

Kindergarten your child will be attending*

Please indicate any allergies or medical conditions of which we should be aware*

If a sibling is attending, please indicate if they should be in the same group or separated.

Please keep siblings in the same groupSiblings can be in separate groupsN/A

Please check all that apply

I am interested in participating as a volunteer during Safety VillageI do not wish to have my child's picture used in local publications or the JWCS Facebook pagePlease do not share my contact information with this year's sponsor(s). (It will not be shared with any other entity).

To give consent for your child to participate in the Junior Woman's Club of Sparta Safety Village please choose yes below and add your signature (type your name)*

Yes, I give consent for my child to participate in Safety Village.

Signature*

My Products

Safety Village Registration $75.00

Subtotal $0.00Tax $0.00Total $0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.