Oakland HOPE Volunteer Registration for Minors
Transforming our community by alleviating huger and empowering lives
First Name of Minor *
Your answer
Last Name of Minor *
Your answer
Birthdate *
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/
DD
/
YYYY
First Name of adult completing this form *
Your answer
Last Name of adult completing this form *
Your answer
Relationship to Minor *
Email *
Your answer
Phone Number *
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
Group Name (business, church, volunteer program, school, university, community service, etc.) *
Your answer
Name of Medical Insurance Carrier *
Your answer
Policy Number & Group Number *
Your answer
Minor's Primary Physician *
Your answer
Minor's Primary Physician's Phone Number *
Your answer
Minor's Dentist/Orthodontist *
Your answer
Minor's Dentist/Orthodontist Phone Number *
Your answer
List any food/drug allergies
Your answer
Emergency Contact First & Last Name 1 *
Your answer
Phone Number *
Your answer
Relationship to Minor *
Your answer
Emergency Contact First & Last Name 2 *
Your answer
Phone Number *
Your answer
Relationship to Minor *
Your answer
The above named minor has my permission to participate in the volunteering with Oakland HOPE, hereinafter referred to as Release, hereby agree to all of the terms and conditions of the release.
If you agree, electronically sign with your first and last name (MINOR) *
Your answer
If you agree, electronically sign with your first and last name (ADULT) *
Your answer
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