2019 Safety Town Middle School Volunteer
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Email *
Volunteer Name *
Volunteer email address *
Volunteer's phone number *
Volunteer's Parent Name *
Volunteer's parent email address *
Volunteer's Parent Phone number *
In case of emergency and parent cannot be reached, please contact *
Volunteer's grade and school for 2019-20 *
I am interested in the following session: *
My SECOND choice of sessions would be: *
Have you been a Safety Town volunteer before? If so, when? *
What is your adult shirt size? *
Do you have any special needs that we should be aware of?  Please explain *
Do you have any allergies that we should be aware of?  Please explain and provide treatment plan *
May we text you with reminders about Safety Town? *
Code of Conduct
 As a Safety Town Volunteer, I agree to abide by the following code of conduct.  ● Set a good example for the campers. ● Act responsibly and to ensure my safety and the safety of the campers around me. ● To use appropriate language.  ● To speak respectfully to the campers, the leaders and my fellow volunteers. ● Dress in an appropriate way.  Volunteers are expected to wear the green volunteer shirt provided to them with walking shorts preferably in black, blue or khaki.  Additionally, I agree not to “personalize” my shirt until after Safety Town is over.  Personalizing includes not cutting, ripping, removing sleeves, etc.  Volunteers are asked to also wear closed toe shoes (gym shoes) during Safety Town. ● I agree to arrive on time and to communicate any changes in the schedule to my parents/guardians to ensure they pick me up on time. ● By signing up to volunteer, I agree to attend every day unless I am ill or I have made arrangements with the Site Director in advance. ● I agree to not use my cell phone to text or call friends during the Safety Town session. I  wish to register as a Safety Town Volunteer and agree to abide by the Safety Town Volunteer Code of Conduct. *
Parent Permission
I agree to support my child’s participation and to ensure they abide by the Code of Conduct. *
 In consideration for my child's participation in Safety Town 2019, the undersigned hereby releases BJWC, its representatives, employees, members, executives, sponsors and volunteers, from any and all claims, known or unknown, of liability, costs and damages which may arise from my child's participation in Safety Town activities. I agree that my child has my consent to participate in all Safety Town activities. I further provide my consent for BJWC, its representatives, employees and volunteers to seek emergency treatment for my child if necessary. I agree to accept financial responsibility for the costs related to said emergency treatment. The provisions of this Waiver and Release from Liability are governed by the laws of the state of Illinois. By checking YES, the signer acknowledges that he or she is at least 18 years old, is the parent or legal guardian of the child for whom this registration pertains, has read this Waiver and Release from Liability in its entirety and agrees to all terms within. *
Please indicate T-shirt size *
Mandatory Volunteer Meeting on Saturday, June 8th at 10 AM
Please mark your calendars for a mandatory meeting for all volunteers to be held on Saturday, June 8th at 10 AM at the Awana Room in the Orchard Church, adjacent to the Safety Town site located at 1301 S Grove Ave, Barrington, IL 60010.  Any questions, email bjwcsafetytown@gmail.com.  Thank you in advance for your help this summer!  We look forward to having you!
A copy of your responses will be emailed to the address you provided.
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