Safety Village Registration 2026

Safety Village Registration 2026
Monday, June 22nd - Thursday June 25th
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 also be used for teaching purposes.)*

Area CodePhone Number
Home 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 do not wish to have my child's picture used in local publications or the JWCS Facebook pageI give permission for my child to be photographed in a group photo for use in a craft (not for public posting).
I am interested in volunteering as a Group Leader. Please note, babysitters are not available. We ask that volunteers do not bring siblings or other children along.

ALL 4 DAYS of camp (preferred)Monday, June 22ndTuesdsay, June 23rdWednesday, June 24thThursday, June 25th
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*
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Safety Village Registration $75.00

Subtotal $0.00Tax $0.00Total $0.00
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