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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, May 22, 2015
Eligibility: Children who will enter Kindergarten this fall
Dates:
EACH SAFETY TOWN SESSION/CLASS
WILL LAST ONE WEEK THIS YEAR
Session 1 is June 8-12th Monday-Friday
Session 2 is June 15-19th Monday-Friday
Class Times:
Location:
Morning Session 9:00 - 11:00 AM
or
Afternoon Session 1:00 — 3:00 PM
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 kjscalli@oberlinpd.com
Safety Town is sponsored by The Oberlin Exchange Club, Oberlin Police Department/City of Oberlin,
Oberlin City Schools and many of our Oberlin merchants
SAFETY TOWN REGISTRATION FORM
June 2015
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 8-12)
______Session #2 (June 15-19)
_____ Morning class (9am-11am)
_____ Afternoon class (1pm-3pm)
______Morning class (9am-11am)
______Afternoon class (1pm-3pm)
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, MAY 22, 2015
Please return this form to the Oberlin Police Department or the Eastwood School Secretary
before May 22, 2015. 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 mailed more information after May 22, 2015.
PERMISSION SLIP
I give permission for my child, __________________________, to participate in Safety Town and
it’s field trips, which may include; safety walks and school bus ride to/from Oberlin Splash Zone,
with the understanding that neither the Oberlin Police Department, City of Oberlin, Oberlin Schools
or the Oberlin Exchange Club is responsible for any accidents.
_______________________________________
(Signature of parent/guardian)
_____________________
(Date)