Form

Safe Sitter® Registration Form 2023 - 2024

Complete the following registration form for Safe Sitter® classes.

Safe Sitter® prepares boys and girls ages 11 to 13 to be safe when they’re home alone, watching younger siblings, or babysitting.

Class Date (Only Select One):

Student Name:

Parent/Guardian Name:

Parent/Guardian Email:

Parent/Guardian Phone Number:

Address:

Student Date of Birth:

Gender:

Name student wants to be called in class:

Name of Student's School:

Grade (23-24 School Year):

* By the day of the class the student must be at least 11 years old OR have completed the 5th grade.

In the Safe Sitter® course, a great deal of information is presented in a short period of time. Because we want every child to succeed in the class, 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 in class. If your child needs accommodations, please let us know as soon as possible.

Allergies

Does your child have any allergies such as foods or latex that we should know about?

If YES, please explain:

I agree not to send my child to class if he/she has a contagious illness including rash.

Emergency Medical Permission

In the event of a health emergency, I authorize the Junior League of New Orleans to take my child and seek emergency care at (enter name of hospital):

In the event of any accident or health problem which may require the attention of a physician, I may be contacted at (enter phone number):

If I am not available, (enter name and phone number) is authorized to act on behalf of my child:

Other Terms and Conditions

I will take all responsibility for deciding whether my child is capable and mature enough to babysit.
I understand the importance of having my child attend each class session and arrive on time.
The teaching site 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.
I, the undersigned, consent to the use, reproduction and publication by Safe Sitter, Inc. and/or The Junior League of pictures or recordings taken of my child during the program for publicity purposes.
Acknowledgement 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 Junior League of New Orleans and their respective employees, members, officers and other staff members from liability to us and our child for any and all claims.
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.
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.
By submitting this registration form I agree to the terms listed above and provide my signature as proof of acceptance.
I consent and authorize The Junior League of New Orleans 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

Please type your name and the date as an electronic signature to agree to the terms above.

Payment

Payment of $80 per student must be paid online at the time of registration or Mail Check to JLNO 4319 Carondelet St. New Orleans, LA 70115

Cancel