FALL BREAK CiViL SERVICE Registration

FALL BREAK CiViL SERVICE Registration - Oct 13, 2026
🍂 TAKE A BREAK FROM SCHOOL… NOT FROM HELPING OTHERS! 💙

School may be out for Fall Break, but CiViL Service is IN! Join us this Tuesday for a fun opportunity to spend part of your break making a difference. Bring your energy, and come ready to serve—because helping others is one of the best ways to spend a day off! You’ll meet great people, give back, earn community service hours, and put Character, Values & Leadership into action. No classes. No homework. Just CiViL people doing some good! 🙌

We will have two sessions. Register for the one that works with your schedule:

Session One: 10 AM - 12:30 PM (Maximum 20 students)
Session Two: 12 PM - 2:30 PM (Maximum 20 students)

Lunch: 12 PM - 12:30 PM included for both sessions.

All supplies will be provided.

Location: Touchstone Office is in the back section of Southminster Presbyterian Church - 643 Harding Place. To get to the back section, turn on Danby when you reach Southminster, and then turn right on W. Longdale. Turn into the parking lot just past the house on the corner. See diagram and follow the yellow line on the map.
Participant Name

First NameLast Name
Participant Birth Date

MonthDayYear
Participant phone

Area CodePhone Number
Participant Email
example@example.com
Preferred Shift
Parent/Guardian Permission

If the participant is under 18.
The signature below acknowledges that:
- I agree to allow my student to participate in FALL BREAK CiViL SERVICE. I understand that my student’s participation is a privilege, not a right, and it is at the discretion of the CiViL leadership.
- CiViL has permission to honor my student publicly, including in the media.
- CiViL has my permission to photograph, videotape, audio-record and otherwise use my student’s likeness or speech on the internet, in print, or any other media.
- I release CiViL, Touchstone Youth Resource Services, Inc., and all employees, volunteers, agents and representatives thereof, from all liability for injuries, including death, to the student named above, and for all claims, loss, or damages resulting from the student’s participation in any CiViL activity, including being transported to and from meetings, service projects or other events.
- I assume full responsibility for all risk to my student while they are participating in any CiViL activity, and I assume full responsibility for any loss or damage caused by the student’s behavior while participating in CiViL Service.
- I authorize CiViL to obtain emergency medical aid for my student.
Parent or Legal Guardian Name

First NameLast Name
Parent or Legal Guardian Phone Number

Area CodePhone Number
Parent or Legal Guardian Signature (Required, if participant is under 18)
Participant Signature (if over 18)
Date Signed

MonthDayYear
Should be Empty:

FALL BREAK CiViL SERVICE Registration - Oct 13, 2026

Parent/Guardian Permission