Cloverleaf Safety City 

For students entering Kindergarten in the 2017-18 school year 
Registration Deadline: May 29, 2017 

Dates: Monday, June 12 - Friday, June 16, 2017 

Time: 9 a.m. - 11:30 a.m. 
Friday — graduation ceremony at 11 a.m. 

Who: Children 5 years or older, entering 
Kindergarten for the 2017-18 School Year 

Location: Cloverleaf Elementary School 
8337 Friendsville Rd., Seville, Ohio 44273 

Cost: $55 - Please make checks payable to Cloverleaf Schools. This program is supported through registration fees, PTO and community donations. 
Mail registrations to: Cloverleaf Elementary School, Safety City Registration, 
8337 Friendsville Rd., Seville, Ohio 44273. You may pay by CHECK OR MONEY ORDER 
made out to CLOVERLEAF SCHOOLS 

At Safety City, certified teachers will be teaching age-appropriate rules on bus and traffic 
safety, fire safety, use of seat belts, how to act with strangers, and much more! Children will 
ride Big Wheels around Safety City, take a ride on a Cloverleaf school bus and participate in our 
Vehicle Safety Day which consists of a smokehouse, police and rescue vehicles. Each child will receive a certificate, t-shirt and class photo at graduation on Friday, June 24. 

Child's Name ________________________Birth date ____________________________________ 

Child's Preferred Name or Nickname ______________________Male or Female _________________ 

Parent's Name ____________________ Daytime Phone _____________Evening Phone ____________ 

Mailing Address (include PO Box) ______________________________________________________ 

City, Zip ____________________________ EMAIL _____________________________________ 

Address your child should know if different from mailing address _____________________________ 

Phone number your child should know __________________________________________________ 

T-Shirt Sizes: Small (6-8) 	Medium (10-12) 	Large (14-16) (Circle Choice) 

ANY KNOWN ALLERGIES OR MEDICAL CONDITIONS: 
___________________________________________________________________ 
___________________________________________________________________ 
___________________________________________________________________