Featuring…

First Aid Tips

➣ A SPECIAL GIFT IS SENT TO EACH STUDENT UPON NOTIFICATION OF SAFETY BOOK LESSONS COMPLETED.

➣ EACH LESSON PAGE CONTAINS AN “I PROMISE” TEXT WHERE CHILD, PARENT & TEACHER SIGN & PROMISE.

Safety Pages Created by Lifeline

AGREEMENT & SOLICITATION AUTHORIZATION

Name of Organization (school, police, youth, etc)(

A/C )

Telephone Number

Street City State Zip Date

Print Name of Authorized Organization Official / Title✖

Please Sign Here

Please include our organization to receive an annual supply ofPolice Officer Safety Books at no cost. We understand thatStudent Safety Book representatives shall solicit advertisingsponsors for payment of all stated materials.

We agree to make known the generosity of sponsors whoprovide payment to appear in our supply of Safety Books.

This Agreement shall be entered into Nassau County, New Yorkand governed by the laws of the State of New York which hassole jurisdiction over all matters pertaining to this contract. ThisAgreement, once accepted by Student Safety Books, shall bebinding and not subject to change or cancellation.

If you wish, you may mail a picture or logo/emblem to appear on cover of your supply of Police Officer Safety Books.

I Promise…Always to obey

the traffic cop orCrossing Guard.

I Promise…Never to open the

door to anyonewhen I am alone.

#SB1042A

P.O. Box 570200, Whitestone, NY 11357-0200 (718) 357-4700

– Perforated - Separate Here –

FAX TO: Student Safety Books - 718-357-4702 or Mail to Address BelowVERIFIED ON ___/___/___BY _____________________