The Dominic Trionfo Memorial Fund
P.O. Box 1023, Middle Island, NY 11953
www.dominicmemorialfund.org

Boater and Water Safety Classroom Program 2018 Order Form
*Delivery Spring 2018
For the Delivery Address, please include a person’s name.  If more than one address, please indicate each additional
address below with the corresponding quantity or indicate each address on a separate form.
Each kit includes 30 activity books, 30 parent
letters, and a teacher guide.__________________
Please complete the additional information below about how these books will be distributed.  
Please indicate grade, how many classrooms per grade, and approximately how many students per
class.
Please contact us at info@dominicmemorialfund.org
with any questions or with additional information.
Thank you for being a part of our Boater and Water Safety Program!

Please press submit after filling out this form.  Thank you.
Update:  Please submit by 03/06/18.