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Safety Town Student Registration: Now Open

Children born between June 2019 - June 2021 are eligible to attend


Birthday
Month
Day
Year
Gender
Male
Female
Prefer Not To Say

Emergency Contact Name & Number (If different from above

Medical Information

Authorized PIck-Up List

(Any persons authorized to pick up your child must be listed here- this includes additional parents, grandparents, nannies/babysitters, friends, parents of another child attending, etc)

Tshirt Size
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
Adult XL
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In consideration of this application to participate in Safety Town, All participants, intending to be legally bound hereby, for myself, my heirs, executors and administrators, waive and release Safety Town Northwest Arkansas, Lisa Academy and any and all sponsors and representatives, successors, and assigns from any and all rights and claims for damages my child may have arising out of any injuries and illnesses suffered in this event.

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I authorize staff to administer basic first aid if needed

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I hereby give my consent for the above mentioned child to be photographed at Safety Town. I also agree that they may use or permit others to use the negatives or prints in such a manner as they deem necessary.

***PAYMENT - when redirected to the following page, select payment method under Express Checkout at the top of the page first (otherwise your payment will not go through and registration will be rejected)
$125
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