Fillable City of Thornton Youth & Teen Volunteer Corps (City of Thornton)

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City of Thornton Youth & Teen Volunteer Corps (City of Thornton)

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The City of Thornton Youth & Teen Volunteer Corps (City of Thornton) form is 2 pages long and contains:

  • 2 signatures
  • 8 check-boxes
  • 40 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Thornton

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City of Thornton Youth & Teen Volunteer Corps
Please complete this form and return to:
Jenny Dowdell
720-977-5934
Jenny.dowdell@cityofthornton.net
Please complete thoroughly:
Name: Date:
Address: City: Zip:
Email:
Home Phone: Birth Date:
School Attended:
Emergency Contact Name: Relationship:
Phone : Email:
Best number to reach emergency contact during our program hours
Do you have any medical condition/s that would limit your ability to perform your duties as a volunteer?
Do you have reliable transportation to and from the various volunteer projects?
Yes No
If you do not have transportation to our projects, do you have transportation to the Thornton
Community Center located at 2211 Eppinger Boulevard? Yes No
Do you have your own mask to wear at every project? Yes No
Are you doing this program for documented community service hours? Yes No
*You will need to provide documentation to be signed by staff at each volunteer project you attend!
References:
Name: Phone: Relationship:
Name: Phone: Relationship:
Name: Phone: Relationship:
Applicant Signature:
Please turn over and complete the back
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signature
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In the event of an emergency, staff will make every effort to contact the Emergency Contact on the front
of this form.
Emergency contact to call if parent can not be reached and medical authorization may be obtained:
Name: Phone #
Address: Relationship:
Name: Phone #
Address: Relationship:
Hospital of Choice:
Name/Address Phone #
Any Allergies or Health Problems we need to be aware of:
Special Instructions:
Emergency Medical Authorizations:
I, , hereby give my permission to the City of Thornton Staff to call a doctor
for medical or surgical care for my child, , should an emergency situation
arise. I also authorize Medical Personnel to treat my child once they arrive.
It is understood that a conscious effort will be made to locate me or my spouse before any action will be taken,
but if it is not possible to locate us, this expense will be excepted by us.
Signature of Parent or Legal Guardian Date
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City of Thornton Youth & Teen Volunteer Corps (City of Thornton)

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Completed 5 August 2020

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