The
Please be advised that if we do not have the number of volunteers needed on any given Friday or Saturday night, the
Thank you in advance for your support as the
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 6th GRADERS ONLY !!
A parent must come with you when you turn in your registration form(s) and membership fee.
www.rocklandteencenter.org
ANNUAL FEE IS $20. Due by November 1st
PAYMENT MUST BE RETURNED WITH THIS
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
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 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.
394 UNION STREET
ROCKLAND,
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
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.
ROCKLAND TEEN CENTER/RULES & REGULATIONS 2011-2012 The teen center facility is open and available to all Please note: all parents and other adults visiting the · Members should always have their current Teen Center ID card with them. If you are a paid member and forget your card, you will be required to pay $1 at the door. Anyone who has not purchased a new membership card by Nov 1st. will have to pay a guest fee of $3 to enter. · No drugs, alcohol or smoking of any kind at any time either inside the building or on the surrounding grounds. Anyone attempting to gain entry who appears to be under the influence of drugs/alcohol will be turned away at the door and will be denied entrance. No food or drinks are to be brought into the teen center. · The Teen Center Facility (including materials and equipment) must be respected at all times. Anyone identified as purposely defacing and/or damaging said property will be responsible for returning/replacing it in the condition in which it was found originally. If graffiti is discovered, the · Please respect all members and the property of others in attendance, keeping hands to yourself at all times. Use of abusive, obscene or profane language including racial, religious, or sexual references directed at other members in attendance will NOT be tolerated and may result in suspension of Teen Center privileges. · Any inappropriate or disruptive behavior will not be permitted in the center, on center grounds or at · Emergency exits & fire extinguishers are for EMERGENCY USE ONLY! There is only one non-emergency door to enter & leave the · Once members in grade 6 are at the center, they must remain there until 10: · Members in grades 7-12 may leave the center before 10 PM, but they may not return again that night, unless arrangements have been made with an adult staff member before leaving the center. · Please DO NOT arrive at the center early. If you are dropping off a member, please remain on the grounds until you are sure the The · We are occasionally closed for special events, holidays or due to inclement weather, please check the local cable channel or log onto www.rocklandteencenter.org when in doubt. Also, if we do not have the minimum number of adults to supervise, WE WILL NOT OPEN THE DOORS. During football season or other special events, we sometimes have delayed openings. · · As the · Any member who is asked to leave the We encourage all Please remember the HAVE A GREAT TIME!