Back to School Community Bash – Service Provider Registration

Back to School Community Bash – Service Provider Registration

Register to volunteer complimentary services for children and families at the event.
Business/Professional Name
Contact Person

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Business Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Social Media Handles (Instagram, Facebook, etc.)
Profession/Service Type
License Number (if applicable)
Years of Experience
Services to Be Provided
Estimated Number of Clients You Can Serve
Number of Professionals Attending from Your Team
List Equipment You Will Bring
Will you need access to electricity?
Do you need table(s) and/or chair(s) provided?
Please describe your space requirements (e.g., size, special needs)
Do you have liability insurance?
Preferred Setup Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Additional Comments or Questions
Electronic Signature
Date

MonthDayYear
Date
Thank you for registering to volunteer at the Back to School Community Bash! Accepted participants will receive additional event details prior to the event. – Jay Mack Community Foundation
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