Groton Youth Services March & April 2017 Elementary
March & April Elementary School 2017 Registration Form Name of Participant: ________________________________ Address:__________________________________________
Groton Youth Services March & April 2017 Elementary
Date of Birth: ________________Grade: ________ Parent/Guardian Name______________________________ Home Phone: ____________ Work Phone: ______________ Emergency Contact Name: ______________________ Phone: ______________ Allergies or medical conditions :_____________________
Please Check All That Apply _____ Yes, I give permission for my child to participate in Groton Youth Programs in March & April 2017 _____ Yes, I give permission for my child to participate in program evaluations for the purpose of assessing the program’s value. Any information gathered will remain anonymous. _____ Yes, I give permission for program staff and/or other emergency care personnel to administer first aid or medical treatment in the event of an emergency involving my child. _____ Yes, I give permission for my child’s photo to be taken during activities and for these photos to be used for documentation and publicity purposes. _____ Yes, I understand that my child must ride the late bus or I must pick my child up at the end of each program and that supervision of my child is not provided beyond program time, unless otherwise arranged.
Parent Signature: ________________________________ Date: ______________________
Open to Children in 1st through 5th Grades Program Manager: Monica Dykeman Phone: 237-2723
Check out these Fun Programs! Boys in Charge: Come out and enjoy this boys only program where we will do the things you want to do– outdoor exploration, science experiments, building fun and more! >Tuesdays, March 7—April 25 2:50-4:20pm
Girls
with Gusto: The girls chance to do things their way! Enjoy science and technology challenges, group games, outdoor fun and more. >Wednesdays, March 29– April 12 2:50-4:20pm Homework
Helpers/ Spring Fun: Catch up on classroom or homework assignments or just get a little extra help during the first half of this program For the second half, we will be celebrating winter’s end with ways to have fun this spring! Please be aware that we will be going out-
Groton Youth Services Programs Registration Form March & April 2017 Please check up to 2 programs your child would like to attend. ______ Boys in Charge: Tuesdays: 3/7—4/25 2:50-4:20pm
______Girls with Gusto: Wednesdays: 3/29— 4/12 2:50-
4:20pm
side some days so proper clothing required. >Thursdays March 3—April 27 2:50-4:20pm
______Homework Helpers/ Spring Fun: Thursdays, 3/2– 4/27 2:50-4:20pm _______Check if participant will need to ride the late bus.
SPACE IS LIMITED.
REGISTER TODAY!!
Detach and return completed form to the elementary school main office.
Groton Youth Services March & April 2017 Elementary
Date of Birth: ________________Grade: ________ Parent/Guardian Name______________________________ Home Phone: ____________ Work Phone: ______________ Emergency Contact Name: ______________________ Phone: ______________ Allergies or medical conditions :_____________________
Please Check All That Apply _____ Yes, I give permission for my child to participate in Groton Youth Programs in March & April 2017 _____ Yes, I give permission for my child to participate in program evaluations for the purpose of assessing the program’s value. Any information gathered will remain anonymous. _____ Yes, I give permission for program staff and/or other emergency care personnel to administer first aid or medical treatment in the event of an emergency involving my child. _____ Yes, I give permission for my child’s photo to be taken during activities and for these photos to be used for documentation and publicity purposes. _____ Yes, I understand that my child must ride the late bus or I must pick my child up at the end of each program and that supervision of my child is not provided beyond program time, unless otherwise arranged.
Parent Signature: ________________________________ Date: ______________________
Open to Children in 1st through 5th Grades Program Manager: Monica Dykeman Phone: 237-2723
Check out these Fun Programs! Boys in Charge: Come out and enjoy this boys only program where we will do the things you want to do– outdoor exploration, science experiments, building fun and more! >Tuesdays, March 7—April 25 2:50-4:20pm
Girls
with Gusto: The girls chance to do things their way! Enjoy science and technology challenges, group games, outdoor fun and more. >Wednesdays, March 29– April 12 2:50-4:20pm Homework
Helpers/ Spring Fun: Catch up on classroom or homework assignments or just get a little extra help during the first half of this program For the second half, we will be celebrating winter’s end with ways to have fun this spring! Please be aware that we will be going out-
Groton Youth Services Programs Registration Form March & April 2017 Please check up to 2 programs your child would like to attend. ______ Boys in Charge: Tuesdays: 3/7—4/25 2:50-4:20pm
______Girls with Gusto: Wednesdays: 3/29— 4/12 2:50-
4:20pm
side some days so proper clothing required. >Thursdays March 3—April 27 2:50-4:20pm
______Homework Helpers/ Spring Fun: Thursdays, 3/2– 4/27 2:50-4:20pm _______Check if participant will need to ride the late bus.
SPACE IS LIMITED.
REGISTER TODAY!!
Detach and return completed form to the elementary school main office.
