Camper Registration Form 2019
A COPY OF THIS FORM MUST BE SUBMITTED WITH A CHECK OR MONEY ORDER. Please fill in the information, confirm that it is correct, print it BEFORE you press "Submit" and mail it to the address below. Fee for 1st & 3rd session is $125; $110 for 2nd sessions because of the Fourth of July holiday, July 4 and 5.

Mail the printed copy and payment to Evanston Safety Town c/o Emily Guthrie, 1003 Dobson Street, Evanston, IL 60202. Sorry we do not accept payment online in order to avoid the fees.
* No refunds after June 1 unless we have a waiting list that we can pull from to fill the seat.
* 50% scholarships available to children who qualify for free and reduced lunch. Please provide a copy of the documents.
* No residency requirements. Everyone is welcome.

MORNING 9:30 - 11: 30 AM OR AFTERNOON 1 - 3 PM
June 24 - July 3 Mon - Wed (closed July 4-5) 8 days. 2nd session. MORNINGS ONLY. Reduced fee of $110. 6 spaces left.
July 8 - July 19 Mon - Fri 3rd session. 10 days. Fee is $125. Afternoon session has a few spaces left.

LOCATION
Camp is on its own little town at Lincolnwood School, 2600 Colfax Street, Evanston, just west of McDaniel, and in the kindergarten wing at the west end of the building. Parking lot is on Grant Street and limited parking on Colfax on the north side of the building, Street cleaning restrictions apply and the City tickets and tows.

EVANSTON SAFETY TOWN is a summer day camp program for 4 - 7 year olds. Established in 1977 by the Evanston/Skokie Council of PTAs, the camp teaches safety rules in a fun-filled setting. A teacher is assisted by volunteer teen counselors (grades 6, 7, 8 and 9) and an older teen aide.

Safety rules are reinforced on the child-sized "town" on the playground including buildings, "cars" (trikes and bikes) and camper's own bicycles and helmets on specified days. Classroom activities include projects, videos, books, puzzles and games for the topics. Campers attend either the two-hour morning or afternoon session for two weeks in June or July. Firemen, police, bicyclers, and a trained service dog may visit. The topics are online at www.evanstonsafetytown.org.

Classes are limited to 40 campers and 12-15 teens. Groups will be seated together if requested. Please consider a car pool as parking is limited.
Choose session dates
Camper's last name *
Your answer
Camper's first name
Your answer
Age on June 1, 2019
Your answer
T-shirt size: children's sm, med or large or adult sm, med or large *
Your answer
Street address
Your answer
City and zip
Your answer
Email address for confirmation
Your answer
Primary contact phone: home/cell
Your answer
2nd phone in case of emergency
Your answer
3rd phone in case of emergency
Your answer
Parent/guardian name(s)
Your answer
Field trip and photo authorization
I authorize my child’s participation in a short field trip walking near the camp to practice safety rules such as crossing the street. I also authorize group photographs for publicity purposes for the Evanston Safety Town website and brochures and occasional newspaper articles and television news programs.
Your answer
Emergency/Medication permission/Special needs/ Accommodations
I authorize any emergency medical treatment necessary. Please list physical limitations, allergies or food restrictions below. Please identify special needs or accommodations. EpI pens should be labeled with name & phone number.
Your answer
Signature of parent/guardian
PLEASE PRINT THIS FORM BEFORE YOU HIT "SUBMIT." Otherwise you will have to fill in all the information again. Then mail the form with a check to 1003 Dobson, Evanston 60202. The first page has information for you to keep.
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