Impact Outreach Registration – Hands On Thomas County

YOUTH ORGANIZATION SUMMER VOLUNTEERING OUTREACH REQUEST.

Please do not leave any fields blank or you may have issues submitting the form. If a question does not pertain, just put NA. THIS FORM WILL NOT WORK WITH INTERNET EXPLORER.

Name of Your Group/Organization

Physical Address

TELL US ABOUT YOUR YOUTH GROUP/ORGANIZATION

Please tell us a little about your summer programming for youth:

What days and times are convenient for your youth group to volunteer?

How many kids do you expect to participate at one time?

What is the age range of the kids you expect to participate? Please note: the minimum age is 10 or 5th grade.

How many adults will accompany your group? Please note: we require a minimum of one adult per 8 kids.

Does your organization have transportation to project sites?

YES

Are your kids able (and permitted) to take supervised walking trips to a project site near your facility?

YES

Will all of your kids have a signed liability waiver/permission form on file from a parent?

YES

Does your agency have liability insurance in case of an accident or injury?

YES

Policy Number

Are there any agencies or projects that you and your group would not be comfortable working with/at? Please describe:

Does your group have any special needs or concerns we should be aware of?

Submitted By

Title

Mailing Address

Office Phone

Your Cell Phone

Your Email