Volunteer Registration Form
Host name: Autism Society of Boulder County
Camp dates: July 22, 2019 - July 26, 2019
Camp location/address: Ascent Community Church 550 S. McCaslin Blvd Louisville, CO 80027

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 Kelly McPherson at bikecamp@autismboulder.org

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) *
e.g., 123 Parker Pl.
Your answer
Home Address (City) *
e.g., Fairfax
Your answer
Home Address (Zip Code) *
5 digits only, please. e.g., 22011
Your answer
Home Address State/Province *
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
What school/organization are you from?
Your answer
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