Volunteer Registration Form
Host name: The Arc of Midland
Camp dates: May 6, 2019 - May 10, 2019
Camp location/address: Midland Evangelical Free Church 7221 N Jefferson Ave Midland, MI 48642

We are pleased to offer this bike program to people with disabilities and look forward to having you play an important part in helping our riders learn to ride a two-wheel bicycle independently.

***NO PRIOR EXPERIENCE WORKING WITH PEOPLE WITH DISABILITIES IS NECESSARY***

AGE REQUIREMENT: Volunteers must be at least 15 years old.
If you are under 15, please contact the Camp Host for possible opportunities.

For questions please contact Susan Drumright at susanandray@charter.net

Volunteer Name *
First Name Last Name
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
T-shirt size
E-mail address *
Please ensure you have entered a valid email. The Camp Host will use this address when corresponding with you.
Your answer
Cell Phone *
Please enter 10 digits
Your answer
Home Address (Number and Street) *
123 Any Pl.
Your answer
Home Address (City) *
Wonderful
Your answer
Home Address (Zip Code) *
24578 (5-digits)
Your answer
Home Address State/Province *
Virginia
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Please enter 10 digits
Your answer
Parent/Guardian Email (if volunteer is under 18 y/o)
Your answer
Comments
Your answer
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