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Volunteer Service Waiver of Responsibility Form
For Students Participating in the
Twin County Community Foundation Scholarship Program
Through
Wytheville Community College
Spring 2024
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Email
*
Your email
Timesheet Rules
TCCF Volunteer Waiver of Responsibility
First Name of Student:
*
Your answer
Last Name of Student:
*
Your answer
Student ID:
*
Your answer
Student's Email:
*
Your answer
Student's Phone Number:
*
Your answer
Volunteer Rules
Name of Volunteer Agency:
*
Your answer
Agency's Contact Person's First Name:
*
Your answer
Agency's Contact Person's Last Name:
*
Your answer
Agency's Mailing Address:
*
Your answer
Agency's City, State, and Zip Code:
*
Your answer
Agency's Phone Number:
*
Your answer
Agency's Contact Email Address:
*
Your answer
Agreement
Student's Signature
*
Your answer
Date
*
MM
/
DD
/
YYYY
Parent or Guardian's Signature (if student is under 18 years of age)
Your answer
Date
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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