2018 Brighton Safety Town Application
Regular Program (children going into kindergarten)
* Child's Last Name
* Child's First Name
* City
* Zip
* Address
* Gender
*Child's Birth Date
* Phone Number
I grant my permission for my child to participate in all activities related to
the Brighton Safety Town Program, including a bus field trip. I hereby
understand and agree that I shall not, in anyway, hold Brighton Safety Town
and any of The Safety Town Staff responsible for any injuries or accidents
that might occur to my child while attending Brighton Safety Town.
* Parents Signature
In signing, I give Brighton Safety Town permission to use my child's photo for their website,
Facebook page, or the newspaper to show the community what safety town is all about.
*Please Specify your 1st and 2nd Choice
June 25- June 29   *FULL*
9:00am- 1:00pm
July 9-13     *FULL**
9am- 1:00 pm
July 16- July 20   ** FULL**
9:00am- 1:00pm
I would like to arrange my child to be in the same color group as his/her friend:
Friend's Name
Registration is on a first come, first serve basis. If you wish to register
your child for the 2018 Safety Town Program, please submit this form
and your registration fee of $75.00.
* Designates Required Field
* Email Address
Youth 5/6

Youth 7/8
Brighton Safety Town has t-shirts available for only $10- sign up today to get
your child a great shirt to wear this summer! Please pay with registration fee
and you will receive your shirt on the first day!  
**Please choose the appropriate size for your child**
* If you receive an error message once you hit submit - it is due to a pop up blocker and
were sorry for the inconvenience. However - we still receive your application.  Please only
submit one application!*  Thanks!
Payment ($75.00)

PayPal option! (Pay today to verify your spot!)
**Payment option after emergency card**

If you do not have PayPal...

Please send check to:
Brighton Safety Town
5841 Fonda Lake Dr.
Brighton, MI