Safe Sitter WC- June 26

Safe Sitter - Washington County

Friday, June 26
This Safe Sitter session will be held at the Washington County Community Learning Center.

Washington County Community Learning Center

1707 N. Shelby Street

Salem, IN 47167
Student's Name

First NameLast Name
Student's Age
Student's Grade Level (fall 2026)
Phone Number
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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

Clear
Please verify that you are human*
Should be Empty:

Safe Sitter - Washington County