SIAN VENTURES LLC RESGISTERED INDEPENDENT SAFE SITTER INSTRUCTIOR Registration For Safe Babysitting Classes are $65 location tbd Please enable JavaScript in your browser to complete this form.1Student Details2Additional information3Parent/Guardian Information4Medical Information5Safe Sitter® Additional Terms and Conditions6PaymentStudent DetailsName *FirstLastEmail *Phone NumberGender *MaleFemaleDate Of Birth *Grade *Additional informationShare a little information about yourself.NextAddress InformationAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States of AmericaUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweCountryPreviousNextParent/Guardian Information A great deal of information is presented in a short period of time during the Safe Sitter® course. We want every child to succeed in the course, and we will work with you to make alternate plans if your child has difficulty keeping up. Please let us know if there is anything about your child that we should know to help your child succeed. If your child needs accommodations, please let the Instructor or Site Coordinator know as soon as possible.Parent/Guardian Full Name *FirstLastParent/Guardian Email Address *Parent/Guardian Phone Number *PreviousNextPlease list any allergies your child has (such as food or latex) *In the event of a health emergency, I authorize Sian Ventures llc to seek emergency care for my child. *YesNoIf I am not available, I authorize the following individual to act on behalf of my child. (Full name) *Authorized individual's phone number. *Manikin PracticeSafe Sitter® includes practice of rescue skills on CPR manikins. Manikins require strict standards for controlling infection.I agree not to send my child if he/she has a contagious illness including rash. *YesI give permission for my child to practice on the manikins. *YesConsent to Photograph/VideotapeI hereby give my consent (as checked below) for our staff to take and use photographs and videotapes for the following purposes: Individual or group photographs or videotape taken during Safe Sitter classes *ApproveNot ApprovePhotographs or videotape to be used on our website. *ApproveNot ApprovePhotographs or videotape to be used on our Facebook Page *ApproveNot ApprovePhotographs to be used in our printed material (e.g., brochures, newsletters). *ApproveNot Approve If I verbally object to a photograph or videotape at the time it is to be taken, such objection will be honored whether or not a consent form has been signed. Names will NOT be published unless approved.NextSafe Sitter® Additional Terms and Conditions I will take all responsibility for deciding whether my child is capable and mature enough to babysit. Sian Ventures LLC reserves the right to decline the application of any student, or send home any student who, according to the site's discretion, is disruptive or puts him/herself or others at risk. I, the undersigned, consent to the use, reproduction and publication by Safe Sitter, Inc. and/or Sian Ventures LLC of pictures or recordings taken of my child during the program for publicity purposes. Acknowledgement of Risk of Injury/Release and Waiver. I acknowledge and understand that there may be a risk of injury involved in the activities that my child will engage in during the program. In consideration of my child's participation in the program, I hereby agree to release, waive, hold harmless, and shall indemnify Safe Sitter, Inc. and Sian Ventures LLC and their respective employees, members, officers and other staff members from liability to us and our child for any and all claims I, the undersigned, have read this release and understand all of its terms. I execute it voluntarily and with full knowledge of its meaning and significance. I, the undersigned, hereby certify that to the best of my knowledge, my child is able to safely participate in the program activities for which he or she has been registered. I, the undersigned, hereby certify that to the best of my knowledge, my child is able to safely participate in the program activities for which he or she has been registered. I consent and authorize Sian Ventures LLC to submit the name and address of my child to Safe Sitter, Inc. I understand that Safe Sitter, Inc. will not sell, share or trade this information with other organizations. Parent/Guardian Signature *Safe Sitter® Student ContractThe Safe Sitter® course is a medically accurate child care course developed especially for students in grades 6-8. Safe Sitter® teaches you the skills you need to safely care for children – infants through school age. We want your Safe Sitter® course to be a positive experience for you! We want you to know what to expect from us when you take the course and we want you to know what we expect from you. With those points in mind, please read the following ground rules for the Safe Sitter® class. Attendance. There is a lot to learn in a fairly short time so it’s important to come to all sessions, be on time, and stay until the end of the course. If this is not possible, you should reschedule for another course. Respect for others. You have a great opportunity to meet new people and develop friendships. We will expect you to think of the feelings of others – no teasing or putdowns. Respect for property and equipment. The class will be fun and the atmosphere relaxed, but students must remember that the space and the equipment must be treated with respect. Student materials. Please write your name in your Student Handbook and be sure to bring it back to each course session. Take your Student Handbook home after the course – it’s yours to keep. Electronic devices. Keep cell phones and electronic devices on silent and put them away during class. You can check for messages at lunch or after the course. Please be sure that any electronic devices brought to class do not distract anyone during the course. Safe Sitter® courses are always lots of fun for everyone. The ground rules are meant to help guarantee that fun. Sign below if you are willing to abide by them. I understand the importance of Safe Sitter’s ground rules. I agree to follow them in the course.Student Signature *NextSafe BabySitting *Price: $ 65.00Total$ 0.00Cash PaymentWe only accept Payment in Cash and should be paid on the first day of class.GDPR Agreement *I consent to having this website store my submitted information so they can respond to my inquiry.PreviousCommentSubmit