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Children's Lyme Disease Education Program RSVP Form

  1. Town Seal
    Children's Lyme Disease Education RSVP Form

  2. Event Details

    This free presentation will be held on Friday, August 9, at 11:00 am at the Cedar Beach Nature Center in Mount Sinai. This program offers children's activities that help them learn the important safety habits to be aware of and prevent tick bites and diseases. Education is essential in combating Lyme Disease which is spreading among our youth. Ages 5 to 14. Each child will receive a "No-Ticks-Please" sling backpack filled with an education and fun packet, tick ID cards and more! Learn More

    All children must be accompanied by an adult / parent / guardian. Please park in the main parking lot and walk to the nature center using the trail that starts by the basketball court.

  3. Please enter the name(s) of the children attending and any additional notes.

  4. Electronic Signature Agreement*

    By checking the "I agree" box below, I hereby grant permission to the Town of Brookhaven, New York, its legal representatives, agents, and assigns without charge, for the use of photographs and/or video taken of said minor in print or electronically produced images. This authorization to use such photographs and images is continuous and may only be withdrawn by my specific rescission in written form. I do give permission by this Release to the Town of Brookhaven and/or its legal representatives, agents and assigns to use the name of the minor(s) subject of this Release in any publication of the within images.

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  6. This field is not part of the form submission.