Safe Kids Fayette County Coalition Partner Information Form

Safe Kids Fayette County logoYes! I would like to be a part of Safe Kids Fayette County (SKFC) and pledge to eliminate unintentional childhood injury by participating in the coalition through community action, educational interventions, public policy initiatives, and media efforts.

Contact Information
May we list your name/organization as a Safe Kids Fayette County member in local, state, and national literature?
Would you like your agency/organization website linked from the Safe Kids website?

I/We will support the coalition’s injury prevention efforts in the following injury areas (check all that apply):

Which committees are you interested in?

I understand that acceptance of this application by the coalition does not constitute permission to use the Safe Kids Fayette County logo, name or materials without first receiving approval from the Safe Kids Fayette County’s lead agency (The Kentucky Children’s Hospital). The lead agency will not authorize and will not permit any member of the coalition to authorize any person or organization to use the name and trademarks to promote its products or services for endorsement or other commercial purpose.

Our Contact Information

Safe Kids Fayette County
Kentucky Children’s Hospital
1000 S. Limestone 
Lexington KY 40536-0293
Call 859-323-1153
Fax 859-257-2292
www.safekidsfayettecounty.com