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Babysitting Class Registration
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First Name
Last Name

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First Name
Last Name
Contact Information
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
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I give permission for my child to have his/her picture or video taken a the Chautauqua Children's Safety Education Village and to have these photos or videos as a part of a press release, on our website, in any media including Facebook, Instagram and other social media sites, on television, in videos created to display our classes for advertising purposes. I confirm that I am the legal parent or guardian of the child on this application form.
Please Note

Your submission will not be finished until payment information has been completed.  We use PayPal; however, you DO NOT need your own PayPal account to pay.  You are able to use any credit card type that PayPal accepts.  Once completed, you will receive an email confirmation.  Please contact us with any questions.  Thank you!