Safety Program Request Form

We are pleased to offer safety classes area schools and community groups. Please complete the following form and we will respond with availability and class confirmation. Please contact us at (716)338-0170 or lisa@chautauquasafetyvillage.com with any questions.

School / Organization Name *

Contact Name *

First Name

Last Name

Email *

Verify Email *

Phone *

Grade Level(s) *

Approximate number of students/participants *

Preferred month or specific dates that you would like *

Please note: the end of April, May, June and October are peak season times for our traffic and bike safety classes. Other topics may need to be scheduled during other times.

Preferred day(s) of the week *

(Click all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Delivery Platform Options: *

Safety Village Zoom - Virtual

In Person at the Safety Village

At your school/organization

Program you would like to attend *

Virtual lessons take less time than in-person classes. In-person times are listed by the program.

Pre-K & Kindergarten: Fire Safety, and Pedestrian, Crosswalk, Poison Safety (2 hours)

Grade 1: Fire Safety and Traffic Safety (2 hours)

Grade 2: Advanced Fire Safety and Scooter Safety (2 hours)

Grades 3-5: Bike Safety (1.5 to 2 hours)

Grades 3-8: Home Alone Safety (2 hours)

Grades 5 - 8: Personal Safety (45 minutes)

Grades 4-8: Basic Child Care & First Aid (1.5 to 2 hours)

Grades 9-12: Distracted Driving (1 to 2 hours)

Mixed Grades: Determine best topics w/ CSV staff

Do you have any additional information you would like us to know?