Taking SAFESTART Home

Help us help other children

At the SafeStart Company, our goal is make a significant reduction in the number of children dying accidentally every year around the world, and we could use your help.

You can make a difference by presenting SafeStart to a school or “not for profit” organization, such as Boy and Girl Scouts and church groups. Simply fill out the form below and we will send the resources to you, with our permission to use them for your group, FREE OF CHARGE.

Please provide us with the following information:

Your Name:
Address:
Address:
City:
State:	Zip:
Phone:	(Daytime)
E-mail:

Name of school or “not for profit” group:

Brief description of your intended SafeStart presentation:

Requested resources:

You can use the SafeStart Home Kit you received at your workplace, or we would be happy to send an additional copy as needed.

	YES, please send an additional copy of the SafeStart Home Kit to my address above.

	Please send (fill in quantity*) of the Boo Boo Bandits Game Cards and Wrist Bands.

	Please send (fill in quantity*) of the SafeStart Keytags.

	Please set up a SafeStart Online Course Account for the group identified above. I will need a maximum of (fill in quantity*) accesses for this account. I will be the administrator for this account and understand that an email will be sent to the email address I have provided giving me additional information on my role.

	I have some other ideas about how to use SafeStart to help people. Please have someone contact me to discuss them. I can be reached during the day at the above phone number or email address.

	I will send a follow up e-mail/letter about my presentation to the SafeStart Company to share with other groups that want to help children. (Photos and video clips would be great, too!).

Larry Wilson, author of SafeStart

"I hope this training helps to keep more children safe."

*Note: We reserve the right to limit quantities.