Worksite Project Request Form - Spring Serve Saturday 2022

Your Contact Information
Your Organization's Name *
One Sentence Description of What Your Organization Does *
Your Name *

First Name Last Name
Your Title *
Your Email Address *
example@example.com
Your Phone Number: Office *
Your Phone Number: Mobile *
Will you be the onsite supervisor the day students come to volunteer? *

Yes, I will. No, someone else will be the day-of supervisor.

Onsite Supervisor
Provide the name and mobile phone number of the worksite supervisor, if someone other than you.
Who will be the Onsite Supervisor (person welcoming and supervising volunteers? *

First Name Last Name
Onsite Supervisor's Title *
Onsite Supervisor's Email *
example@example.com
Onsite Supervisor's Phone: Office *
Onsite Supervisor's Phone: Mobile *

Signatures
By signing electronically below, I agree to host a worksite team from The Hartford Project on the above selected date(s), and confirm that I or the otherwise listed onsite supervisor will be present to welcome and instruct volunteers upon arrival.

I also agree to keep volunteers in safe working conditions, follow government guidelines regarding COVID-19, and to never ask participants to work with or near poison ivy.
Your Signature

Clear
Onsite Supervisor's Signature

Clear
Should be Empty: