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Parents:     Child:       Child DOB:  
Gender:        School Grade:       School:

Street:   City, State, Zip:  Phone:
Dad's Phone:     Employer:   Occupation:
Mom's Phone:   Employer:   Occupation:

Emergency Name:   Phone #:
Family Doctor:        Phone #:

 Class:     Register Date:       Register #:  
 Paid For?        Notes:      Email:
T-Shirt Size:        

Current Safety Village Registration *
ClassRegister DateRegistration NumberPaid For?
15/1/2017 10:50:31 AM21418582Y
34/24/2017 12:33:53 PM39160924Y
14/17/2017 4:50:23 PM48219241Y
44/17/2017 11:19:21 AM82372798Y
46/12/2017 6:31:17 PM113314987Y
36/8/2017 8:02:28 AM141693382Y
14/26/2017 9:24:06 AM185240897Y
66/9/2017 10:11:46 AM264702737Y
36/16/2017 7:48:01 AM319431731Y
66/12/2017 7:21:25 AM342918312Y
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* When 1 class is listed and payment is shown as recieved, your child is completely registered for that class. You will also receive a confirmation email when this happens.

Class History
Class IDClass AgesSessionStart DateEnd DateMax StudentsActiveNotes
0006Age 8-10Afternoons06/26/201706/30/201740Y2017 - AM class for 8-10 year olds
0003Age 5-7Mornings06/19/201706/23/201740N2017 - AM class for 5-7 year olds
0004Age 5-7Afternoons06/19/201706/23/201740N2017 - PM class for 5-7 year olds
0001Age 5-7Mornings06/12/201706/16/201740N2017 - AM class for 5-7 year olds
0002Age 5-7Afternoons06/12/201706/16/201740N2017 - PM class for 5-7 year olds
0005Age 5-7Mornings01/14/201701/18/201740N2017 - extra class if needed


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