Safety Town Student Registration
Registration for Safety Town 2025 is CLOSED.
We hope to see you next year!

Sorry, but this form is now closed.

Student Registration

Child's First Name

Child's Last Name

Birthday

Month

Day

Year

Cell Phone

Address (Street, City, State, Zip Code)

Parent/Guardian Name

What phone number should we teach your child at Safety Town?

Emergency Contact (Name & Phone Number)

Physician/Clinic for your child

Physician/Clinic Phone #

What school will your child attend in the Fall?

List any medical issues, allergies, physical handicaps, etc. your child may present with

Is there anything else we should know about your child?

T-Shirt Size

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 Arkasnas, Trinity Fellowship Assembly of God 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.

Parent/Guardian Signature

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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. (Safety Town promo only)

Parent/Guardian Signature

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PAYMENT - when redirected to the following page, select payment method at the top of the page first.

$100

Safety Town Student Registration Registration for Safety Town 2025 is CLOSED. We hope to see you next year!

Student Registration

Safety Town Student Registration
Registration for Safety Town 2025 is CLOSED.
We hope to see you next year!