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TeenScene_Summer 2017

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22 www.townofcary.org Membership Application 2017-2018 Membership Applications will be accepted beginning June 1. Register using course code 105212 or mail to: Cary Teen Council Herbert C. Young Community Center 101 Wilkinson Avenue, Cary, NC 27513 *New for 2017/18 – there will be a limited amount of spots available for new member registration. Updated information will be available by May 24 at www.townofcary.org by searching 'Teen Council' For more information, contact Doug Peters at doug.peters@townofcary.org or by phone at (919) 460-4965. 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 2017-2018: Grade 2017-2018: ❑ 6 ❑ 7 ❑ 8 ❑ 9 ❑ 10 ❑ 11 (Seniors not accepted as new members) Fees: ❑ Cary Resident $25 ❑ Non-resident $35 (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 14 ❑ Tuesday, July 11 ❑ Tuesday, August 8 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 E S TA B L I S H E D 1 9 8 9

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