Safe Sitter - April 11

Safe Sitter - Seymour

Saturday, April 11
This Safe Sitter session will be held in the Mary Schneck Conference Room in the Schneck Professional Building on Level 1.
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.
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
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Safe Sitter - Seymour