Free Membership - Form - Join the Children's Safety Association of Canada

Membership Form

Receive a free safety pack which includes our 32 page Child Safety Reference Manual, "HOT" Stickers - to help prevent scalding accidents, Child Print/Identification Kit(s) - to identify each child and Window Blind Safety Kit(s) - to prevent related accidents.
Note: Safety pack is available only in Canada.

Contact Information

Title:
First Name:
Last Name:
Address
City:
Province:
Postal Code:
Telephone:
Email:

Member Information

Home:
# of Blinds:
Family:	# of children:
	Ages:	1	2	3	4	5	6

Comments

Do you have any suggestions or questions? Yes No

E-mail Updates

Would you like to receive updates by e-mail? Yes No

Home page