Groton Youth Services March & April 2017 Middle School
Groton Youth Program March & April Middle School 2017 Registration Form Name of Participant: ________________________________ Address:__________________________________________ Date of Birth: ________________Grade: ________
Groton Youth Services March & April 2017 Middle School
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 and 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 Students in 6th through 8th Grades Program Manager: Monica Dykeman Phone: 237-2723
Check out these Fun Programs! Spring Fling: Spring is here! Let’s celebrate with everything spring– crafts, activities, games, and getting outdoors. Hopefully we will even be able to explore and clean up trails behind the school. Please be sure to dress for the weather and possible mud! >Monday March 6– April 10 2:45-4:45pm
Program Helpers: Do you enjoy helping younger kids? If so this may be the perfect thing for you! If selected, you will come to the elementary school to help with afterschool programs. Please speak to Monica before signing up for this program as you need to be approved
Groton Youth Services Programs Registration Form March & April 2017
Elementary
>Tuesdays March 7 - April 25 or Thursdays March 2– April 27 2:50-4:20 pm
Keep an eye out for sign ups for Junior Camp Counselor Training beginning in April!
Please check your child would like to attend. ______ Spring Fling: Monday, March 6– April 10
2:45-4:45pm
______Elementary Program Assistant: 2:50-4:20pm Check One: _____ Tuesdays, March 7– April 25 _____ Thursdays, March 2– April 27 _______Check if participant will need to ride the late bus.
Detach and return completed form to the school main office.
SPACE IS LIMITED. REGISTER TODAY!!
Groton Youth Services March & April 2017 Middle School
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 and 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 Students in 6th through 8th Grades Program Manager: Monica Dykeman Phone: 237-2723
Check out these Fun Programs! Spring Fling: Spring is here! Let’s celebrate with everything spring– crafts, activities, games, and getting outdoors. Hopefully we will even be able to explore and clean up trails behind the school. Please be sure to dress for the weather and possible mud! >Monday March 6– April 10 2:45-4:45pm
Program Helpers: Do you enjoy helping younger kids? If so this may be the perfect thing for you! If selected, you will come to the elementary school to help with afterschool programs. Please speak to Monica before signing up for this program as you need to be approved
Groton Youth Services Programs Registration Form March & April 2017
Elementary
>Tuesdays March 7 - April 25 or Thursdays March 2– April 27 2:50-4:20 pm
Keep an eye out for sign ups for Junior Camp Counselor Training beginning in April!
Please check your child would like to attend. ______ Spring Fling: Monday, March 6– April 10
2:45-4:45pm
______Elementary Program Assistant: 2:50-4:20pm Check One: _____ Tuesdays, March 7– April 25 _____ Thursdays, March 2– April 27 _______Check if participant will need to ride the late bus.
Detach and return completed form to the school main office.
SPACE IS LIMITED. REGISTER TODAY!!
