Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

What grade will you enter during the 2024-25 academic year? *

11th Grade/Junior

12th Grade/Senior

I'm pursuing an undergraduate degree

I'm pursuing a graduate degree

Do you have CPR or First Aid certification? *

Yes

No

Which week(s) are you interested in volunteering? *

Check all that apply.

Week 1: Week of June 10

Week 2: Week of June 17

Week 3: Week of June 24

Which days of the week are you available to volunteer? *

Check all that apply. Volunteer shifts are for three hours (minimum) between the hours of 9 a.m. and 3 p.m.

Monday

Tuesday

Wednesday

Thursday

Friday