2023-2024 Medfield Youth Action Club (YAC!) Student Interest Form

Thank you for your interest in joining the Medfield Youth Action Club! (YAC!) at Blake Middle School. Please fill out the form below.

Not sure yet? Email Medfield Outreach Prevention Coordinators with any questions you have.

  • Meri Haas, mhaas@medfield.net
  • Kyler Groner, kgroner@medfield.net

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Name (first and last)  *
Preferred name/nickname (if different from name above)
Email *
Grade  *
I am available from 2:15 - 3:00PM on Tuesdays  *
Do you have any questions about YAC! ?
What excites you about joining YAC!? 
Parent/guardian name (first and last)  *
Parent/guardian email

We will send a YAC! permission form to this email. 
 *
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