The Rockland Teen Center celebrates its 18^th year of operation with the 2011-12 school year. As you may already know, the Teen Center and the Teen Center Advisory Board is strictly a volunteer organization. Advisory Board members contributed countless hours of their time to keep the center open the past 5 years after the retirement of Bill and Joanne McCormack who previously ran the center for 13 years. 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 year’s membership forms, parents are being asked to sign up for a minimum of one evening per school year to help supervise at the center. Please check your schedule and let us know when you can volunteer. You can schedule as far in advance as you would like. In addition to signing up on the membership form you may also email us at rocklandteencenter@yahoo.com.  You may also stop by the Teen Center some evening and let us know.

Please be advised that if we do not have the number of volunteers needed on any given Friday or Saturday night, the Teen Center will NOT open the doors. Please keep this in mind when dropping anyone off. We strongly suggest that you wait to be sure we have the number of people needed to open before dropping anyone off and leaving.

          Thank you in advance for your support as the Rockland Teen Center re-opens for its 18^th year.

           From this packet, please sign and return (1) the membership form and (2) medical release form along with the $20 annual fee. Thanks.

IMPORTANT  FOR  INCOMING  6^th GRADERS  ONLY !!

A parent must come with you when you turn in your registration form(s) and membership fee.

          ROCKLAND TEEN CENTER
            2011-2012 Membership For
              394 UNION STREET
           ROCKLAND, MASSACHUSETTS 02370
              781-878-9008    
                    www.rocklandteencenter.org
       ANNUAL FEE IS $20. Due by November 1st
          PAYMENT MUST BE RETURNED WITH THIS FORM.

Member name: _____________________________________________
Date of Birth: _______________       Current grade 2011-2012: __________
Address___________________________________________________
Parent's home phone: _________________ Parent's Cell: ______________
Member's cell phone: ________________________
E-Mail Address of PARENT: _____________________________________

I, as the parent/guardian of                                         __________ have read the attached rules and regulations and allow my child to attend the Rockland Teen Center. I understand that members in grade 6 cannot leave the center before 10:00 PM without making arrangements in advance with the staff and/or contacting a parent for permission to leave early. Members who are being picked up at 10:00 PM should be picked up promptly. Members who are still on the community center grounds after 10:15 PM will be considered trespassing.

I understand that parents are expected to volunteer a minimum of one evening per school year. Please indicate below a tentative date you would be willing to volunteer. You will receive a reminder call a few days before the date you have signed up for.

a Friday ______    a Saturday ________      Month __________   Date __________

Parent’s or Guardian’s signature:____________________________________                                                                              

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: ______________________________                                                         

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 and the medical release form must be signed and returned along with the $20 annual membership fee.

ROCKLAND TEEN CENTER
394 UNION STREET
ROCKLAND, MASSACHUSETTS 02370
781-878-9008
www.rocklandteencenter.o
MEDICAL RELEASE FORM

 
Member Information _____________________________________________________
                                                                                Name

                                       ____________________________________________________
                                                                                Address

 In the event of an injury or sudden illness sustained while attending the Rockland Teen Center and/or its related activity,  I authorize the adult(s) in charge to authorize the transfer of my child to an emergency facility for treatment by qualified personnel.

 All reasonable efforts to reach me at _______________________________________

 or ______________________________________________________ will be made.
                                     (Two different phone numbers please)

 I accept responsibility and release the Rockland Teen Center, the Town of Rockland, and/or all employees and volunteers of same, from all obligations and liabilities connected to the transfer of my child for medical treatment.

                                                 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.

ROCKLAND TEEN CENTER/RULES & REGULATIONS