320 North Main Street Slippery Rock, PA 16057 Monday – Friday 8:00am-3:30pm

PlaySafe Registration

The Playsafe Registration is required each school year. There’s an administration fee of $25 per family due upon registration. Please be sure to complete this registration form before scheduling.

Please use the form below to register and pay for PlaySafe.

Choose Your School(Required)

Slippery Rock

Moraine

How Many Children Are You Registering?(Required)

Childs Name(Required)

First Last

Teacher(Required)

Grade(Required)

Allergies(Required)

Second Childs Name(Required)

First Last

Teacher(Required)

Grade(Required)

Allergies(Required)

Third Childs Name(Required)

First Last

Teacher(Required)

Grade(Required)

Allergies(Required)

Mother's Contact Information

Mothers Name(Required)

First Last

Email Address(Required)

Phone(Required)

Mother's Address(Required)

Street Address Address Line 2 City State ZIP Code

Father's Contact Information

Same Address As Mother(Required)

Yes

Fathers Name(Required)

First Last

Email Address(Required)

Phone(Required)

Father's Address(Required)

Street Address Address Line 2 City State ZIP Code

Pick-up Authorization

Please list at least two names, beside yourself, whom you authorize to pickup your child. If you are divorced, please list other parents name, if they are permitted to pickup your child. If there’s a court order involved, please provide a copy to the park office.

Name(Required)

First Last

Name(Required)

First Last

Name

First Last

Name

First Last