Babysitter’s Training

Course Registration

Please print legibly:

_____________________________________________________

Name of course participant (as it should be printed on the card)

_______________ ________________________________

Date of Birth* Phone number

____________________________________________________

Address

_____________________________________ __________

City Zip Code

I want to register for Babysitter's Training being held on

the following dates/time:

_______________________________

_______________________________ ___________________

Parent/Guardian name Alternate phone # to

contact parent in case

of emergency

Amount enclosed: _______________ _____cash _____check

* youth must be 11 years old by the last class session to be eligible

for certification

For West Bend Chapter Use Only

Date enrolled: ______ Receipt #: ___________________

Date confirmed: _______