Name: Safe Sitter Class
Start: 2020-02-24T08:30:00-04:00
End: 2020-02-24T15:30:00-04:00
Location: Frisbie’s Community Education & Conference Center

Upcoming Events & Classes

Safe Sitter Class

Safe Sitter is designed to prepare students in grades 6-8 to be safe when they’re home alone, watching younger siblings, or babysitting.

The instructor-led class is filled with fun games and role-playing exercises. Students even get to use manikins to practice rescue skills like choking rescue and CPR.

Safe Sitter Pre-registration

To preregister for an upcoming Safe Sitter class, please complete the Safe Sitter Preregistration form. Payment must be received within 7 days to confirm class spot.

Student Name*
First Last
Student Birth Date*
Date Format: MM slash DD slash YYYY
Grade in School*
Student must be in grades 6-8.
Gender
- Male
- Female
Parent/Guardian*
First Last
Phone (Home)*
Phone (Cell)
Phone (Work)
Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Email*
Select Class Date:*
Class is held from 8:30am - 3:30pm
Dear Parent/Guardian(s):*
A great deal of information is presented in a short period of time during the Safe Sitter course. We want every child to succeed in the course, and we will work with you to make alternate plans if your child has difficulty keeping up. Please let us know if there is anything about your child that we should know to help your child succeed.
- Yes, I will take responsibility for deciding whether my child is capable and mature enough to babysit.
- Yes, I understand the importance of having my child attend each course session and arrive on time.
Allergies*
Please let us know if your child has any allergies, such as to certain foods or to latex.
- No
- Yes* please describe below
*My child has the following allergies:
Manikin Practice*
Safe Sitter includes practice of rescue skills on CPR manikins. Manikins require strict standards for controlling infection.
- Yes, I agree not to send my child if he/she has a contagious illness including rash
- Yes, I give permission for my child to practice on the manikins.
Emergency Medical Permission:*
In the event of a health emergency, I authorize Frisbie Memorial Hospital (site) to seek emergency care for my child. Please provide us with the name of your preferred hospital (in the event of an emergency), your contact phone number, and the name of the person that you authorize on your behalf if you are not available.
Preferred Hospital: My Contact Number: Authorized Person: Authorized Person's Number:
Other Terms and Conditions:*
1. The teaching site (Frisbie Memorial Hospital) reserves the right to decline the application of any student, or send home any student who, according to the site's discretion, is disruptive or puts him/herself or others at risk.
2. I, the undersigned, consent to the use, reproduction and publication by Safe Sitter, Inc. and/or the teaching site of pictures or recordings taken of my child during the program for publicity purposes.
3. Acknowledge of Risk of Injury/Release and Waiver. I acknowledge and understand that there may be a risk of injury involved in the activities that my child will engage in during the program. In consideration of my child's participation in the program, I hereby agree to release, waive, hold harmless, and shall indemnify Safe Sitter, Inc. and the teaching site and their respective employees, members, officers and other staff members from liability to us and our child for any and all claims.
4. I, the undersigned, have read this release and understand all of its terms. I execute it voluntarily and with full knowledge of its meaning and significance.
5. I, the undersigned, hereby certify that to the best of my knowledge, my child is able to safely participate in the program activities for which he or she has been registered.
6. By submitting this registration form I agree to the terms listed above and provide my signature as proof of acceptance.
7. I consent to authorize Frisbie Memorial Hospital to submit the name and address of my child to Safe Sitter, Inc. I understand that Safe Sitter, Inc. will not sell, share or trade this information with other organizations.
I have read and accept the Terms and Conditions.
Signature of parent/guardian:*
Please type your name to acknowledge that you accept Safe Sitter's Terms and Conditions.
Today's date:*
Date Format: MM slash DD slash YYYY
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