Playsafe 2017-2018 In the event of a delay, Playsafe will be open 7:00am-10:45am. Weekly Playsafe Form- Weekly schedule-Playsafe form School Attending Moraine Slippery Rock Child's Name Grade Teacher: Please list an medical concerns or food allergies. Second Child's Name Grade Teacher: Please list an medical concerns or food allergies. Mother/Legal Guardian Name Mother/Legal Guardian Address: Mother Phone/cell number Mother E-Mail: Father/Legal Guardian Name Father/Legal Guardian Address: Father Cell phone: Father E-mail: Please list at least two names, besides yourself, whom you authorize to pick-up your child. 1. Name: 2. Name: Names of emergency contact, if parent is unavailable: 1. Full Name and Number 2. Full Name and Number The Park will not be responsible for any toys, hand held games or personal belongings your child/children brings to PlaySafe. My child/children and I agree to abide by the Park's rules and regulations in order to maintain the safety and security of this program.