Kids Safe City 8110 S. Ferdinand Ave. Bridgeview IL. 60455
Not-For-Profit Organization
Summer Camp 2012
This camp is like no other! Designated for children ages 4-10 years old.
Children will experience and Practice:
This program offers:
Location:
Dates: Monday, June 18th - Friday, June 22th
Monday, July 9th - Friday July 13th
Monday, August 6th - August 10th
Cost: $70 per child (Family Discounts Available)
Each child is required to bring a sack lunch!
Registration is OPEN!!!! CALL to reserve your spot!!!
If you have any questions or would like to register, please
contact Toni Wokosin at (708)227-1129
or email at kidssafecity@att.net
Field Trips
(Available from April through October!)
Choose from any programs listed below:
Birthday Parties
Have your next Special
Birthday Party with us!
We offer 3 Party Packages
Package A: $100 Guided safety themed party
Package B: $125 Package A plus goody bag for
all kids
Package C: $150 Package A & B plus cake or
cupcakes
We will set up and clean up for you!
Just provide the food and invite the kids!
Scout Programs
For Daisy's, Brownies, And Cub Scouts
Meet your requirements with Kids Safe City!
Have you run out of ideas for Scout Meetings?
Let Kids Safe City help! Many Scout badge requirements can be filled just by completing one of our programs. Call to reserve your spot today!
Contact Toni Wokosin at 708-227-1129
or
email us at kidssafecity@att.net
Below are all forms needed to participate in our Programs.
It's as easy as clicking the left part of your mouse and highlighting the form below. Then select print from the File tab at the top left of your computer screen.
After selecting print, a print window pops up. In "print range" choose "selection" this will tell your computer to print only the highlighted selection you choose. Then send or bring the form into Kids Safe City. Hurry and sign up soon, Registration is OPEN!!
Kids Safe City
8110 S. Ferdinand Ave.
Bridgeview, IL 60455
Summer Camp Registration
Child's Name:___________________
Age: _____ (on day of registration) Birthday (mm/dd/yyyy) ___________
Mother’s Name: _____________________
Cell: (___) _____________
Father’s Name: ____________________
Cell: (___) _____________
Address: ________________
City: ________________Zip: _________
Home Phone: (____)_______________
Email: __________________________
Other Emergency Contacts for your child, list below:
1. Name:______________________
Phone:______________________
Relationship:_________________
2. Name:______________________
Phone:______________________
Relationship:________________
*In case of an emergency which parent/emergency contact should be contacted first?
Name:_____________________________
Child Release Authorization
I, ______________________ give permission to the following people, other than myself, to pick up my child.
1. Name:______________________
Phone:___________________
Relationship:_________________
2. Name:______________________
Phone:_____________________
Relationship:________________
Doctor
Name:____________________
Phone:______________________
Address:____________________
City:_________________Zip:________
Please indicate any medical information or special accommodations your child requires. (Allergies, disabilities, illnesses, behavior problems, etc.)
____________________________________________________________________________________________________________________________
If applicable, please supply any medication with detailed instructions. Your signature below gives us permission to distribute the medication as directed to your child.
Parent Signature: ______________________________
Date: _________________________
Please circle t-shirt size:
Small Medium Large
*How did you hear about us? ____________________________
*Are you interested in having a child’s Birthday Party at our facility? YES/NO
*If so what Month_____________________
*Are you interested in receiving information regarding up coming events?YES/NO
*If yes how would you like to be informed? Circle one (email, phone, mail)
*Are you interested in volunteering or do you have a service that could assist Kids Safe City? YES/NO
*If yes list service______________________________________________
We truly appreciate volunteers at Kids Safe City.
***************FOR INTERNAL OFFICE USE ONLY!*****************
T-shirt received: Registration:_________ 1st Day of Program: _____________
Program Total: $___________
Check Number: __________
Cash: ____________
Date Paid:___________
Initials:_________
