AmeriCorps Name Waiver

AmeriCorps Name Waiver
During 2019, you may be participating in a class or activity run by Tammy Wittmann, an AmeriCorps member serving SOAR Fox Cities. One requirement of the AmeriCorps program is to track attendance by ONLY keeping names of participants.

Complete this waiver ONLY if you are giving permission to have your name included.
You may include the name of this participant on any health education log that is shared with the AmeriCorps program. *
Name of SOAR Participant
Select one:*

I am filling this form out for myself. I am 18 or older and am guardian of myself.As a parent/guardian, I am filling this form out for the above mentioned SOAR participant.
Should be Empty: