2014 Winter Playground Program

2014 City of Sherrill Holiday Events
Christmas Tree Lighting!
The Sherrill Merchants Association will host a Christmas Tree Lighting on Thursday December 4
at 7pm in Reilly-Mumford Park. Celebrate the beginning of the season!
Santa’s Arrival!
The City of Sherrill invites you to join in the arrival of Santa Claus on Sunday, December 7 at
7pm at the Sherrill Community Activity Center. Refreshments will be served.
Winter Playground Program
Come to the CAC Monday-Wednesday December 29-31 and Friday January 2 from 10am12pm! Play in the gym, make crafts, and have fun! This program is open to children who
attend E.A. McAllister elementary school who are in kindergarten-sixth grade. Bring the form
on the back to the CAC on the first day you attend!
Other Activities during the Holiday Break
-Bowl at the CAC December 22, 23, 26, 29, & 30 and January 2 from 12-5pm, On December 31,
New Year's Eve, the CAC will be open for bowling from 12pm-midnight.
-The Ice Skating rink will be open weather permitting.
-Youth Center for VVS students in grades 4-6 Mondays & Tuesdays- 12/22, 12/23, 12/29,
12/30, 6-9pm.
-Please note- the CAC is closed 12/24, 12/25 and 1/1.
2014 City of Sherrill Winter Playground Program Registration and Authorization Form
____________________________________ (Participant’s name) has my permission to attend the Winter Playground
Program located at the CAC 139 East Hamilton Avenue Sherrill, New York. I give the City of Sherrill and its duly
authorized representatives the authority to seek any medical attention my child may need in the event he/she is injured
in my absence. This includes ambulance transportation to any medical facility and any medical treatment. I understand
that all attempts will be made to contact me at the listed telephone numbers, but treatment will not be delayed because
I cannot be contacted. I further authorize any physician, hospital, or medical attendant to receive full and complete
medical reports or information deemed necessary by them with respect to the treatment of my child. Execution of this
document shall operate as an authorization for such person(s) to receive any medical information that they require.
Date______________ Parent/Guardian Signature _________________________________________________
Child’s Name: ________________________________________ Date of Birth______________ Grade: _______
Parent/Guardian Name: ______________________________________________________________________
Address: __________________________________________________________________________________
Telephone: ____________________________ Email Address: ______________________________________
Additional person to contact in case of an emergency (if parent/guardian cannot be reached):
Name: __________________________________________________ Relationship: _____________________
Phone: _____________________________ Address: ______________________________________________
Does your child have any health issues, allergies, or take any medications we should be aware of? If yes,
please explain:
Please check one or more of the following:
______ Walk or Bike Home Alone
______ Will be picked up by _____________________________________
Phone Number ________________________________________