(For students ages 11-14)
I would like to be a volunteer for Burlington Jaycees Safety Town this summer at Waller School. I understand that I am expected to be available every day for two weeks from June 16-27, 2007. Please fill in the information below and mail to:
Kathy Szmanda
Burlington Jaycees Safety Town
P.O. Box 312
Burlington, WI 53105
Forms should be received no later than May 16th. We regret that not all who apply are chosen to participate. If you are selected, a confirmation letter will be sent to you by May 30th.
Name_________________________________________________________________M / F________
Address____________________________________________________________________________
Phone number_______________________________________________________________________
Current School and Grade_____________________________________________________________________________
Parent Signature___________________________________________________________________________
Adult T-Shirt size __________Small __________Medium __________Large
Session Preferred: Morning (9:30-11:30)______ Afternoon (12:30-2:30)______
Either session______
Brother/sister/friend you would like to be grouped with_________________________________
Instructors are under the supervision/direction of a licensed teacher and police officer and are responsible for helping to teach the children about safety. This is a volunteer position, and can count toward community service hours if desired. You will be asked to attend a training session. Further information, as well as the date and time of the training session, and an instructor guide will be mailed to you. Instructor t-shirts are furnished by the Burlington Jaycees. An appreciation party or event will also be held for the instructors after the program is completed.
*This activity is not sponsored by the Burlington Area School District and the Burlington Area School District does not approve or disapprove, support or endorse this activity/program.