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
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*
Please keep siblings in the same groupSiblings can be in separate groupsN/A
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).
ALL 4 DAYS of camp (preferred)Monday, June 22ndTuesdsay, June 23rdWednesday, June 24thThursday, June 25th
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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