Student Service Hours Volunteer Form
Students, please complete this form only with the permission of your parent or legal guardian. If you have questions, please feel free to contact Leah by email to Media@CityofCharlestown.com or by call or text: 502-631-2506.
Student Volunteer Name
First Name
Last Name
Email Address
example@example.com
Student Grade
Phone Number
-
Area Code
Phone Number
Ok to text this number?
Yes
No
Contact me via text or email about future service hour opportunities?
Yes Please
No Thank You
Parent or Guardian (Emergency Contact)
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Service Hours are available for the following dates, please select all that you or your student are interested in working. Student groups may work cleanup shifts with their own adult sponsor, or be assigned to a Parks Department employee or Charlestown Beautification Committee volunteer. Dinner will be provided for any student working both the Halloween Parade and Movie event.
Halloween Parade on Market Street (Sat, 10/17, 2020) 5pm - 7pm shift
Movie in the Park at Charlestown State Park (Sat, 10/17) 7pm - 10pm shift
Sunday Morning Cleanup - Parade Route (8am - ?)
Sunday Morning Cleanup - Charlestown State Park (8am - ?)
I am interested in service hours in the following areas:
Cleanup Events
Youth Sports
Public Art
Beautification Efforts
Media (Photography, Video, etc)
Please let us know if your student requires any physical or other accommodations. If you have a particular skill, talent or interest you'd like to contribute for service hours (photography or video, first aid, experience coaching or working with youth, arts, musical performance, underwater basket-weaving, etc.) - please describe below. You may also use this space to add any additional details you see fit as needed.
I have my parent or legal guardian's permission to complete this form, or am completing this form on behalf of my student (please initial below):
Submit
Should be Empty: