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2024 Babysitting Training Scholarship Request

The Safety Village can offer 3 scholarships per course date. These are issued on a first come, first serve basis. Please complete the form and a staff person will reach out to confirm class availability.

Youth Name

First Name

Last Name

Youth Age

Parent or Guardian Name

First Name

Last Name

Number of People in Your Household

Annual Household Income

$0 - $19,999

$20,000 - $29,999

$30,000 - $39,999

$40,000 - $49,999

$50,000 or Greater

Contact Information

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Verify Email

Parent Phone

Please list any medical information or allergies if applicable

Photo Release

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.

Yes