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Registration Forms for Youth and Volunteers
Youth members under 18 years old Complete Form and send with $5.00 per person. [This covers cost of Dinner, snack and breakfast. ]
Name________________________________________________________________ Address________________________________________________________________ Telephone _________________________ Please Circle: Male or Female
Date of Birth________________
Age as of April 1, 2009_____________
Grange Name __________________________________________________
Officer position if you hold one in the Grange ______________________________________________ Group Member request (If you want to be in a group with someone)________________________________________________________
e-mail ___________________________________________________________________
Date of Birth________________
Age as of April 1, 2009_____________
Grange Name __________________________________________________
Officer position if you hold one in the Grange ______________________________________________ Group Member request (If you want to be in a group with someone)________________________________________________________
e-mail ___________________________________________________________________
Please List two (2) Emergency Contact numbers and addresses.
Name______________________________________ Address__________________________________________________________________________ Telephone _____________________________
Relation to youth member ___________________________________________ Name______________________________________ Address__________________________________________________________________________ Telephone _________________________________
Relation to youth member ___________________________________________
Relation to youth member ___________________________________________ Name______________________________________ Address__________________________________________________________________________ Telephone _________________________________
Relation to youth member ___________________________________________
I, ___________________________ (Parent/Guardian) agree to allow _______________________ (Name of youth) to participate in the Spring Break Youth Sleepover. I have read the letter and know the activities that will be taking place at the event. I am aware that I must check out my child between 10:30 and 11:30 am on Thursday April 16, 2009 at the Bethlehem Grange Hall.
_______________________________ (Parent/guardian signature)
I, _____________________________ (Youth) agree not to: bring any drugs, weapons, or wear inappropriate clothing. I understand that if any of these items are found, they will be confiscated, a parent will be notified, and I will be sent home. I also agree not to use my cell phone during events unless it is an emergency.
____________________________________ (Youth Signature)
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
____________________________________ (Youth Signature)
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Please mail this form to: Emily Thomas 50 Edgecomb Street Albany, NY 12209 or
fax: (518) 463-5709 by March 2, 2009
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Chaperones and Volunteer Registration form [18 and older] Complete forms and send with $5.00 per person. [This covers cost of Dinner, snack, and breakfast.]
Name________________________________________________________________ Address________________________________________________________________
Telephone _________________________ Please Circle: Male or Female
Date of Birth***________________
Grange Name __________________________________________________
Officer position if you hold one in the Grange ______________________________________________
e-mail ___________________________________________________________________
Telephone _________________________ Please Circle: Male or Female
Date of Birth***________________
Grange Name __________________________________________________
Officer position if you hold one in the Grange ______________________________________________
e-mail ___________________________________________________________________
Please List two (2) Emergency Contact numbers and addresses.
Name______________________________________ Address__________________________________________________________________________ Telephone _____________________________
Relation ___________________________________________ Name______________________________________ Address__________________________________________________________________________ Telephone _________________________________
Relation ___________________________________________
Relation ___________________________________________ Name______________________________________ Address__________________________________________________________________________ Telephone _________________________________
Relation ___________________________________________
*** I understand that youth technically runs until the age of 24, for those of you between the ages of 18 and 24 I will ask you to participate by being a group leader. You will still be able to participate in every activity and still be helping keep everyone safe so we can all enjoy our night!
Emz214 |
Latest page update: made by Emz214
, Jan 21 2009, 7:11 PM EST
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