1
Summer Volunteer Application
Addendum for Applicants under 18
Instructions: Complete Page 1 and 2 and return to CASA with Summer Volunteer Application
Volunteer Name ____________________________________________ Email _______________________
Mailing Address __________________________________________________________________________
Street City Zip
(IF APPLICABLE) Student Status: Fr____ So____ Jr____ Sr____ Other _________________________
Name and Location of School ____________________________________________________________________
__________________________________________________________________________________________________
The Summer CASA Volunteer promotes a positive learning environment by assisting the classroom teacher and teaching
assistant with daily activities.
SCHOOL PERSONNEL: The person noted above is applying to be a Summer Volunteer at CASA.
Please complete the following information and return to applicant.
Academic and Behavior Standing
To be completed by two (2) classroom teachers and the school administrator
By signing below, I confirm that the above named student is in good academic standing and has no history of
misconduct. I confirm that this student, to the best of my knowledge, has demonstrated the responsibility and
commitment required to be a volunteer at Summer CASA at Hope College.
Teacher Name
Subject Area
Signature / Date
Comments
1.
2.
Administrator Name
Title
Signature / Date
Comments
Parent Completion on Page 2
263 College Avenue, Graves Hall, B-40 PO Box 9000 Holland, MI 49422-9000
(616) 395-7944 casa@hope.edu www.hope.edu/casa
2
Summer Volunteer Application
Addendum for Applicants under 18
Continued
To be completed by parent or legal guardian
Student Name: __________________________________________________________________________
Parent Name(s): _________________________________________________________________________
I. Emergency/Medical
A. Emergency Contact Name and Relationship: ___________________________________________________
Emergency Contact Phone Number: _______________________________________________________
B. Emergency Contact Name and Relationship: ___________________________________________________
Emergency Contact Phone Number: _______________________________________________________
Permissions
Medical
In case of an emergency and I am not able to be reached, the CASA staff has my permission
to obtain necessary medical assistance for my child.
Publicity
I give permission for CASA to use my child’s image (photos, digital, and video), voice
recordings, and written materials during his/her affiliation with CASA.
Program Participation
I give permission for my minor child to serve as a volunteer at CASA at Hope College.
Parent / Guardian Signature: ___________________________________________ Date ____________
Return ADDENDUM Page 1 & 2 with completed Volunteer Application to:
263 College Avenue, Graves Hall, B-40 PO Box 9000 Holland, MI 49422-9000
(616) 395-7944 casa@hope.edu www.hope.edu/casa
click to sign
signature
click to edit
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