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TeenScene_Sum2019_Bookmarked for web

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18 www.townofcary.org CARY TEEN COUNCIL 2019–2020 *Membership Applications will be accepted beginning June 1 through June 30* New member registration is open to those who are rising 9-11th grade Cary resident teens. Register in person at the Bond Park Community Center, Herbert C. Young Community Center, Middle Creek Community Center or mail-in to: Cary Teen, Council Herbert C. Young Community Center 101 Wilkinson Avenue, Cary, NC 27513 For more information, contact Doug Peters at doug.peters@townofcary.org or by phone at (919) 460-4965. Membership Application Name: ❑ Male ❑ Female Date of Application: Birth Date: Returning Member: ❑ Yes ❑ No Address: City: Zip: Phone #: Email: Parent Email (if you wish to receive communication) Name of Parent(s)/Guardian(s): Name of School 2019–2020: Grade 2019–2020: ❑ 9 ❑ 10 ❑ 11 (Seniors not accepted as new members) Fees: ❑ Cary Resident $25 (Make Checks payable to Town of Cary) T-Shirt Size (adult sizes): ❑ Small ❑ Medium ❑ Large ❑ X-Large ❑ XX-Large New Member Mandatory Meeting All NEW members must attend a new-member meeting prior to volunteering. No refunds if requirement is not met. I will attend on the following date, 6 p.m. at Herb Young Community Center: ❑ Wednesday, June 12 ❑ Tuesday, July 9 ❑ Tuesday, August 13 No one on one assistance will be provided for volunteer work. Individuals requiring a higher level of support may volunteer if they have a personal assistant. Teen Council meets on the 3rd Tuesday each month beginning in August Consent and Waivers I certify the above information is true and complete to the best of my knowledge. I am aware that certain portions of this information may be subject to disclosure under the NC Public Information Disclosure laws. Volunteer's Signature: Date: Parental Consent for Minors to Volunteer In consideration of the Town of Cary, permitting my child to participate as a volunteer in the Parks, Recreation & Cultural Resources department and its associated activities, I acknowledge and agree to the following: (1) I represent that my child is in satisfactory and mental health, physically/mentally able to engage in volunteer work, and is not a danger to themselves or others (2) I am aware that I will be held liable for any misconduct or behavior or unlawful activity that my child may engage in while in a volunteer status with the Town of Cary. (3) I authorize my child to maintain an account on the Cary Teen Council website, to be used solely for its intended purpose. Parent/Guardian Signature: Date: For Office Use Only: ❑ Email List ❑ Address List ❑ Attended New Member Meeting

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