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