REACH's Alternative Breaks Registration Form
If you are interested in registering for REACH's Alternative Breaks program, please fill out the following form. If you are not ready to commit to registering, please contact our staff at reach@reachinroanokeva.org.

Thank you for your interest! We look forward to serving with you!

Contact Information
Please fill out the information below of the main contact for your group.
First and Last Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Group Name *
Name of School and/or Club/Organization.
Your answer
What is your group's affiliation?
What is the start date of your break? *
Approximate date is fine.
MM
/
DD
/
YYYY
What is the end date of your break? *
Approximate date is fine.
MM
/
DD
/
YYYY
What kind of service is your group interested in participating in? *
YES!
OK if assigned.
No, thank you.
Animal Care
Children and Youth
Community Events
Environmental Impact Work
Home Repair and Renovation
Homeless Shelter Work
Hunger Alleviation
LGBTQ+
Older Adult Services
How many distinct service tasks do you see your group participating in? *
(i.e. If you are interested in 8 shifts of 1 home repair site, choose 1. If you are interested in 8 shifts at various service sites, choose 8.)
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