ROCKLAND TEEN CENTER
394 UNION STREET
ROCKLAND, MASSACHUSETTS 02370
781-878-9008
www.rocklandteencenter.org
September 2007
To: ALL PARENTS OF TEEN CENTER MEMBERS
From: Teen Center Advisory Board
As you are probably aware, the Rockland Teen Center has been closed for the summer following the retirement of Joanne and Bill McCormack who served as Directors for the past 13 years. All those who have been associated with the Teen Center over the past 13 years would like to thank Bill and Joanne for their dedication and for the countless hours of their time that they have contributed in service to the youth of Rockland.
Over the summer, a new Teen Center Advisory Board, made up of volunteers, has been put in place to get the Teen Center open again. As the new Board, we wanted to touch base with all parents.
As you know, the Teen Center is strictly a volunteer organization. In order to keep the center open, we need parents to volunteer a minimum of one Friday or Saturday during the year. In that regard, on this years membership forms, parents are being asked to pledge that they will donate one evening per school year to help supervise at the center. If we do not have the number of volunteers needed on any given Friday or Saturday night, the Teen Center will NOT open. Please keep this in mind when dropping your children off, we strongly suggest that you wait to be sure we have the number of people needed to open the doors.
Please check your schedule and let us know when you can volunteer. You can schedule as far in advance as you would like. You may volunteer by going to Teen Center web page. Instructions will be there for contacting us with the date you would be interested in volunteering. You may also stop by the Teen Center some evening and let us know.
Thank you in advance for your support as the Rockland Teen Center re-opens for its 14th year.
Please note, the Teen Center has a new web address: www.rocklandteencenter.org
From this packet, please sign and return (1) the membership form and (2) medical release form along with the $10 annual fee. Thanks.
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ROCKLAND TEEN CENTER
394 UNION STREET
ROCKLAND, MASSACHUSETTS 02370
781-878-9008
www.rocklandteencenter.org
THERE IS A $10 ANNUAL FEE. PAYMENT MUST BE
RETURNED WITH THIS FORM.
Member name:__________________________________________
Address: ______________________________________________
Phone:_______________________
E-Mail Address: ___________________________
Date of birth:___________ Current Grade 2007-08:____________
I, as the parent of __________ have read the attached rules and regulations and have no objections in allowing my child to attend the Rockland Teen Center. I understand that members in grades 6 & 7 cannot leave the center before 9:00 P.M. without making arrangements in advance with the staff. 6th & 7th grades cannot stay after 9:00 P.M. for any reason and cannot loiter outside the building after that time. Any Teen Center members leaving the Center at 9:00P.M. and who are still on the community center grounds after 9:15 P.M. will be considered tresspassing and the Police will be notified. NO EXCEPTIONS!
I understand that parents are expected to volunteer one evening per school year.
Parents signature:_______________________________________
Parents e-mail address (if different from above): ____________________________________________________
I, as a Teen Center member, have read and understand the rules and regulations and will be respectful towards all volunteers.
Teen Center Member signature:______________________________
Once this form & the medical release form are filled out completely, and the membership fee is paid, it will be kept on file at the Teen Center.
IN CASE OF EMERGENCY : We would like to have a second phone number on hand in the event that the parents cannot be reached.
Emergency person: Phone: _______________
Relationship to member:___________________________
This form must be signed and returned.
ROCKLAND
781-878-9008
MEDICAL RELEASE FORM
Member Information _____________________________________________________
Name
____________________________________________________
Address
In the event of an injury or sudden illness sustained while attending the
All reasonable efforts to reach me at _______________________________________
or ______________________________________________________ will be made.
(Two different phone numbers please)
I accept responsibility and release the
Signature of Parent/Guardian _____________________________
Date _____________________________
_____________________________________________________________________
Does your child have any special medical considerations we should be aware of?
Allergies _____________________________________________________________
Medications ___________________________________________________________
Family Physician _______________________________________________________
Other Notes __________________________________________________________
This form must be signed and returned.
