Y.A.H.O.O. (www.sterlingyahoo.org) REGISTRATION FORM

Y.A.H.O.O.
(www.sterlingyahoo.org)
REGISTRATION FORM
Registration Fall Deadline: October 11, 2014
Registration Spring Deadline: March 21, 2015
Send To: Rich Lane
45 Tanglewood Road, Sterling, MA 01564
Age:
Name:
Please print clearly
I graduate from High
Address:
School in the year:
20 ___
Please print clearly
E-Mail:
I will participate in Y.A.H.O.O. on the following dates: (Please circle all that apply)
I need a T shirt / sweatshirt! (Circle One)
Size:
S
M
L
XL
To qualify for prize drawing at the end of the season you must sign up for at least 6 hours (three dates.)
2014 DATES
10/25
11/1
11/8
11/15
2015 DATES
4/4
11/22
Home Phone:
4/11
4/18
4/25
5/2
Work Phone:
(Parent)
Emergency Contact Name:
Phone:
Physician’s Name:
Phone:
Medical Plan Name:
Plan Number:
IMPORTANT
List any allergies your child has and/or any medications needed to be taken
PERMISSION / MEDICAL RELEASE
(Please read carefully before signing)
I give my child permission to participate in the Sterling Recreation Y.A.H.O.O. program. I hereby release, discharge,
and / or indemnify the Recreation committee, the Youth Program Directors, the Town of Sterling, its’ elected officials,
staff, and / or volunteers of any liability related to the operation of this program.
I hereby give my consent for emergency medical care prescribed by a licensed Doctor of Medicine.
I hereby give the Y.A.H.O.O. staff permission to use my child's' name and/or photo in any press releases.
Parent/Guardian Signature
Parent/Guardian Email Address
Date
I have read and understand the Y.A.H.O.O. mission statement.
Youth Volunteer Signature
Date
Thank you
to our
Anonymous
Sponsor!
SOLAR AND KILCOYNE, PC
Certified Public Accountants
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