Level Up Safety Squad | October 20, 2023

3rd Graders are invited to participate in our Level Up Safety Squad program. This event is organized by Madison County Health Care System and provides a safe space for your child to learn about different health initiatives. We will provide healthy snacks, games and fun activities, crafts and safety tips from our pediatrician, Dr. Amy Kimball. They will also have the opportunity to LEVEL UP and win fun prizes by applying what they learn at home, and tracking their activities until our next event in March.

Our first event is Friday, October 20th, from 1:06 pm - 3:30 pm (early-out day for WCSD).

The sign-up is limited to the first 50 students (3rd grade only). We will communicate by email with updates, event information and future event dates.

DEADLINE TO REGISTER: FRIDAY, SEPTEMBER 29th

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* 1. 3rd Grade Child's Name

First Name

Last Name

Teacher's Name

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* 2. Your contact info:

First Name

Last Name

Email Address

Phone Number

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* 3. Secondary contact info:

First Name

Last Name

Email Address

Phone Number

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* 4. T-Shirt size for your child

Youth S

Youth M

Youth L

Youth XL

Other (please specify)

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* 5. Does your child have any dietary restrictions? (Select all that apply.)

My child does not have any dietary restrictions.

Vegetarian

Vegan

Lactose Intolerant

Gluten Free

Nut Allergy

Other (please specify)

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* 6. PHOTO RELEASE: As the parent or legal guardian of the child listed above, I grant Madison County Health Care System permission to use photographs taken at the Level Up Safety Squad events for any legal use, including but not limited to: publicity, copyright purposes, illustration and web content.

Yes