Issue link: http://townofcary.uberflip.com/i/499557
21 Parks, Recreation & Cultural Resources Cary Teen Council Established 1989 Membership Applications accepted in June only. Register using course code 85284 or mail to: CARY TEEN COUNCIL Herbert C. Young Community Center 101 Wilkinson Avenue, Cary, N.C. 27513 For more information, call (919) 460-4965. MEMBERSHIP APPLICATION Name: ________________________________________________________________________ o Male o Female Date of Application: __________________ Date of Birth: ____________________ Returning Member Yes o No o Address: ______________________________________________________________________________________________________ City: ______________________________________________________ Zip: ________________________ Phone Number: ____________________________________ Teen Email: ____________________________________ Parent Email (if you wish to receive information):_________________________________________________________ Name of Parent(s) or Guardian(s):_____________________________________________________________________ School 2015-2016: _________________________________________________________________________________ Grade 2015-2016: 6 7 8 9 10 11 Seniors not accepted as new members. Fee: o $20 Cary Residents o $30 Non-Resident Make checks payable to "Town of Cary" T-SHIRT SIZE (ADULT SIZE): o Small o Medium o Large o XL o XXL CONSENT and WAIVERS I certify that 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 MINOR 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 physical 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: o E-mail List o Address List o Attended new member meeting New Member Mandatory Meeting I will be attending on the following date: o Wednesday, June 24 o Thursday, July 16 o Thursday, August 6 Teen Council meets on the 3rd Tuesday of each month beginning in August * All new members must attend a new member meeting prior to volunteering. No refunds if this requirement is not met.