Safety Town Volunteer Registration

Safety Town volunteer form

* Indicates required field

Name *

First

Last

Age *

Email *

Phone Number *

School *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Will you need a letter for volunteer hours? *

Yes No

T-shirt size *

Social Security Number (required for 18 years and older) *

Emergency Contact Name: *

Phone Number *

Physician *

Phone Number *

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

Coburn United Methodist Church - June 3 - 7, 2019 6:00p.m. - 7:30p.m. Coburn United Methodist Church - June 10 - 14, 2019 6:00p.m. - 7:30p.m. Trinity Lutheran Church - June 24 - 28, 2019 6:00p.m. - 7:30p.m.

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. I understand that I am undertaking the care of small children and affirm that I have full capability to supervise and protect them. I authorize a background check for this purpose.

Volunteer Signature *

Parent's Signature (if volunteer is under 18) *

Plan to arrive 15 mintues 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 reschedule. Parent volunteers will not be in the same group as their child.

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