2025 Safe Sitter - Salem

Safe Sitter - Salem - June 7, 2025

Washington County Community Learning Center
Student's Name

First NameLast Name
Student's Age
Student's Grade Level (fall 2025)
Phone Number
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
By signing below, I give permission for my child to participate in the Safe Sitter Program. I hereby release, remit, discharge and relieve Schneck Medical Center from any and all claims of whatever nature on behalf of my child, arising out of and as a result of participation in this program.
Guardian Signature

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Safe Sitter - Salem - June 7, 2025