High School Community Service Application Form

High School Community Service Application Form
Student Information
Student Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
High School Name
Student ID Number
Grade Level
Total Service Hours Needed
Target date to complete hours

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Parent/ Emergency Contact Information
Parent/ Guardian Name

Guardian First NameGuardian Last Name
Parent/Guardian Phone Number
Format: (000) 000-0000.
Parent/ Guardian Email
example@example.com
Emergency Contacts

Rows	Check If Yes
After School Programs (Mon–Fri, 3:30 PM – 6:00 PM)
Weekend Events & Tournaments (Saturdays/Sundays)
Summer Camp/ Seasonal Clinics
Flexible/ Project-Based (Remote or As-Needed)

Student Information