Safety Town Volunteer Form

Safety Town volunteer form

* Indicates required field

Name *

First

Last

Email *

Age (must be 14 or older) *

Phone Number *

School *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Will you need a letter of hours for school? *

Yes No

Emergency Contact Name *

First

Last

Emergency Contact Number *

Physician *

Physician Number *

Specific Medical Issues: *

By signing, I agree to volunteer for The Carr Center Safety Town Program. In the event of an emergency, I give permission for emergency medical care, such as contacting emergency squad, to be initiated on my behalf. Further, I understand The Carr Center will initiate efforts to contact my emergency contact in the event of any emergency *

Please indicate the session you would like to volunteer (you may volunteer for more than one session) *

June 20 - 24 6-7:30pm Coburn United Methodist Church June 27 - July 1 6-7:30pm Coburn United Methodist Church July 11 - 15 6-7:30pm Trinity Lutheran Church

Shirt size *

Plan to arrive 15 minutes early. Thank you for your interest in The Carr Center Safety Town. You are requested to commit to one entire week of the program. We are hopeful to schedule you for your selected week, however, if conflicts arise, you will be contacted to rescheduled. Parent volunteers will not be in the same group as their child.

Submit