Safe Sitter - July 13

Safe Sitter - Seymour

Monday, July 13
This Safe Sitter session will be held in Classroom 500 in the Schneck Professional Building on Level 5.
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
Please verify that you are human
Should be Empty:

Safe Sitter - Seymour