Volunteer Registration Form
Host name: Mike Michaud
Camp dates: July 23 - July 27, 2018
Camp location/address: Conard High School 110 Beechwood Rd. West Hartford, CT 06107
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 special 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

Volunteer Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
T-shirt size
E-mail address *
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 State/Province *
Virginia
Home Address (Zip Code)
24578 (5-digits)
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Please enter 10 digits
Your answer
Comments
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of iCanShine. Report Abuse - Terms of Service - Additional Terms