Screen Smart Volunteer Sign Up

Volunteer Interest Form

Thank you for helping support a Bell to Bell phone free school day and healthier screen habits in Region 4. Please fill out the form below to help us understand how you'd like to contribute.
Full Name

First NameLast Name
Email Address
example@example.com
Resident of
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
OK to Delay Chester Town LeadTeacher LiasonOK to Delay Deep River Town LeadTell Me How I Can HelpMiddle School Lead/LiaisonHigh School Lead/LiaisonI can commit to spreading the word starting with 5 new petition signers!Event Planning Is My JamI’m just here for the beer -happy to stay informed but can't commit to moreI Can Start/Manage Social Media Accounts (FB and Instagram)State Rep Reachout/State Initiatves
Do you have special skills/experiences you can share? Tell us how you'd like to help
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Volunteer Interest Form