Safety Town Volunteer Information For students who have completed 6th through 12th grade. ------------------------------------------------------------------------------------ Safety Town is an educational program geared toward children ages 4-9. The curriculum involves a variety of a safety topics and issues. As a volunteer, you will work with a small group of students on these topics and you will follow the direction of the lead teacher. Safety Town will be held at Elmore Elementary School, 615 Ethel Avenue. Safety Town runs from 8:30-11:30 am, Monday through Friday. You will need to arrive at Safety Town at least 15 minutes before the children arrive to receive instructions for the day. We are looking for teens that can commit to the full 3 hours a day for the entire week. Being a volunteer at Safety Town is a very important job. The young children need to establish a good relationship with you and they look forward to seeing you each day. We need to know we can depend on you to make a commitment to work through the entire week at Safety Town. As a volunteer, you will be assigned to a group of three to four. Each day, you will meet with your group in a classroom setting at Safety Town. Under the direction of a classroom teacher, you will follow a schedule for the day which may involve listening to speakers such as coast guard, police officers, or a firefighter; watching videos or participating in group activities; all while learning about different safety issues. Children will have a snack every day and learn safety songs. We will also have time to let the children drive cars on our Safety Town set up in the gym. If you enjoy working with young children and would like to be involved in Safety Town, please complete the enclosed application. Completed applications may be mailed to: Safety Town Volunteers, Center for Childhood Safety, 842. S. Military Avenue, Green Bay, WI 54304 or email to [email protected]. Questions? Email Jennie [email protected] or call 920.272.0112. 2017 Student Volunteer Application Form Please print clearly and fill out all information. Student Information Name_________________________ __________________________ Age______ Male Female Address____________________________________________________________________________________________________ street city state zip Parent or home work mobile Guardian______________________ ________phone________________________phone______________________phone________________ Parent or home work mobile Guardian______________________________phone________________________phone______________________phone________________ E-Mail Address___________________________________________ Volunteer confirmation will be sent via email Have you volunteered at Safety Town before? No Yes If yes, when? _____________________________ ____________________ _______________________ T-Shirt size : Small Medium Large X-Large School Attending and Grade Level (Fall 2018) (please circle) shirts are adult sizes Please mark the week or weeks that you are interested in volunteering ______ Session 1 – June 19th – June 23rd 8:00 a.m. –11:40 p.m. ______ Session 2 – June 26th – June 30th 8:00 a.m. –11:40 p.m. ______ Session 3 - July 10th – July 14th 8:00 a.m. –11:40 p.m. ______ Session 4 – July 17th – July 21st 8:00 a.m. –11:40 p.m. The Safety Town staff and children depend on their volunteer. You must be able to attend all five days of the session in which you volunteer. Medical Information : Does your child have any medical concerns or special needs including allergies and asthma? No Yes If yes, please describe special care instructions or other information that may be needed by the Safety Town staff: _____________________________________________________________________________________________________________________ _________________________________________________________________________________________ ____________________________ Emergency Contact____________________________________Relationship____________________________Phone_______________________________ Consent & Release of Liability: I the parent/guardian of _________________________________________(child’s name), for myself and for my minor child, agree to hold harmless and indemnify The Center for Childhood Safety, the owners and lessors of premises on which Safety Town takes place, any agent, director, officer, organizer, supervisor, volunteer or member of such organization from any and all liability, loss, damages, costs, or expenses which are sustained, incurred, or required arising out of the actions of the undersigned in the Safety Town program. I give my son/daughter permission to participate as a Group Leader at Safety Town 2016. My child understands this is week-long commitment and the staff and students will be counting on his/her reliability. I have read and fully understand the details of the program and the above release of liability, indemnity. _____________________________________________ ____________________ Signature of Parent/Guardian Date .