Safety Town Registration
আপনার উন্নতি সেভ করার জন্য Google-এ সাইন-ইন করুনআরও জানুন
Monroe Safety Town
Date Registered *
মিমি
/
মাস
/
বছর
Child's name as you wish it to appear on nametag.       (First and Last Name) *
Child's Address *
Mailing Address (if different)
Parent email address *
Select a session date *
প্রয়োজনীয়
Select a time *
Child's name *
Mother's name & daytime phone number
Father's name & daytime phone number
Medical conditions, allergies, handicaps that should be known to staff
Having made application for my/our child/children to attend Monroe Police Safety Town, I hereby permit said child/children to participate in all activities of said Safety Town. Furthermore, I hereby give my/our consent for emergency medical treatment should that be necessary for the child/children name above at the closest appropriate medical facility. I DO give consent for release of my child's photograph and name (first name only, no addresses) to media for publicity purposes. Digital images (with no names) may also be posted on the City of Monroe website and/or City of Monroe social media outlets. By checking agree,  I/we are hereby certifying that I/we are the parents or legal guardian of the above name child/children and have authority to make these authorizations.   *
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