2. Parents may use this online form to register their child for Safety Town sponsored by the Fairfield Police Department and City of Fairfield Parks and Recreation Department. 

   Fairfield Safety Town introduces safety awareness and practices to kids aged 6-7 years of age. It is an interactive and engaging way for kids to learn everyday life skills and to learn about their surroundings. Safety town empowers kids to make safe and responsible choices at home, school and in the community. Kids learn various safety topics including: pedestrian safety, 911, bicycle safety,  fire and smoke safety, vehicle safety, gun safety, railroad safety, school bus safety, stranger danger, and animal awareness.

6. Child's First Name *
7. Child's Last Name*
9. Address*
11. City
12. State
13. Zip Code
15. Date of Birth*
    Date of Birth
16. Shirt Size*
    -- Select One --Youth XSmallYouth SmallYouth MediumYouth LargeYouth XLargeAdult SmallAdult Medium
18. School Information-Please indicate what grade you will entering and what school you attend.*
22. Consent for Participation*

    1. I consent

    By filling out this application, I acknowledge that the City of Fairfield, their affiliates, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity. 

    I consent to allow my child to participate in all aspects of Safety Town. Daily physical activity will be included and expected unless limitations are expressed in the application. 

    All children are welcome to participate. I understand that if my child with special needs requires a 1:1 aide, I must provide the aide. If your child has any special emergency medical requirements, please be sure to note that on the registration. 

    I understand that all children must be potty trained in order to participate.

    I hereby consent to all appropriate medical treatment for my child which may be deemed advisable in the event of of injury, accident, and/or illness during any activities. 

    In addition, I understand that while participating in this activity, my child may be photographed. I agree to allow their photo, video, or film likeness to be used for any legitimate purpose by the City of Fairfield Police Department and the City of Fairfield Parks and Recreation Department. 

24. Parent/Guardian's Relationship to Student*
26. Parent/Guardian First Name*
27. Parent/Guardian Last Name*
29. Address (If different than the student's)
31. City
32. State
33. Zip Code
35. Parent/Guardian Cell Number*
36. Alternate Contact Number:
38. Email Address*
42. Additional Authorized Person for Pick-Up

    Parent/Guardian listed above is the only individual your child will be released to unless otherwise stated below.

44. First Name
45. Last Name
46. Phone Number
48. Please list any medical concerns that would limit your child from participating in aspects of Safety Town.*

    Please include any medical conditions, medications, or food allergies.  If none, please just indicate NONE.

50. First Choice Session:*
    -- Select One --June 15 - 19, 2026 9:30AM - 11:30AMJune 22 - 26, 2026 9:30AM - 11:30AM
51. Second Choice Session:*
    -- Select One --June 16 - 20, 2025 9:30AM - 11:30AMJune 23 - 27, 2025 9:30AM - 11:30AM

53. Classes are free and will be available on a first come first serve basis. The program is open to children who are a resident of Fairfield and/or those who attend a Fairfield City School or a school in Fairfield and are entering 1st or 2nd grade. Both classes have size limits and once capacity is reached it will no longer be available. A wait list will be generated if a class is full.

57. Waiver & Release for Participation
    Waiver & Release to Print and Sign

    Must present this waiver on or before the first day of Safety Town in order to participate.

59. For Further Details, Questions or Concerns:

    If you have any questions or concerns, please contact Officer Bri Mossman at 513-829-8201. 

Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field