FIRST CHILD:

Child’s name  (First, Last):  
Year of Graduation: 
School: 

SECOND CHILD:

Child’s name  (First, Last):  
Year of Graduation: 
School: 

THIRD CHILD:

Child’s name  (First, Last):  
Year of Graduation: 
School: 

Parent’s name(s)  (First, Last):  
Address:  
Phone:     Email: 

I wish to be listed in my school’s directory as a Safe Homes participant.
I wish to receive periodic electronic Safe Homes newsletters which will provide helpful information on ways to keep my home and our community safe. E-mail me at the above address.

 

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