Adventures In Living Fall
Town of Granby Youth Service Bureau Program Registration
Email address *
An Intergenerational group to promote community connections, foster friendships, build social skills and have fun.
Open to children in grades 4-6, this 6 session program will use games, art projects, and other activities to help bring generations together. Participants will learn about what has stayed the same regarding friendships, and what has changed over time. This group will help foster friendships, build a sense of community connection, and encourage social skills development. Open to children in Granby, East Granby and Hartland. The program runs from 3:30 to 5:00 PM on Mondays. Transportation is provided from Wells Road School to the Senior center. Begins 9/30/19
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Participant's Name *
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Date of Birth: *
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Address *
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School and grade *
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Gender
Parent/Legal Guardian Name *
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Phone Number: *
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Please check here if you do not want your child's photos (without name) published on community sites
Demographics
Race
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Do you need information on reduced fees and scholarships for this program?
Permission and Emergency Medical Information
If your child requires pick up, is there anyone NOT authorized to do so?
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Emergency Contact *
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Relationship *
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Phone Number *
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Are there any specific medical conditions we should be aware of? *
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Are there any specific medical conditions we should be aware of? *
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In case of emergency, if I cannot be reached I give permission to the attending physician to hospitalize, seek treatment, order injections, anesthesia, or surgery for my child named on this form. Additionally I the undersigned, do hereby waive and hold Granby Youth service Bureau, its employees and agent harmless from any personal or property damage I or my child may incur while participating in this activity, I also understand Granby Youth Services does not provide accident or health insurance. In addition by electronically signing and dating below I am indicating my permission for my child to participate in this Granby YSB program: *
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For questions or for more information contact AnneMarie Cox at (860) 844-5355 or email her at ahcox@granby-ct.gov
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