PERT Community Service Application
The Pennypack Trust’s mission is to protect, restore and preserve the lands of the Pennypack Creek Valley. The Trust offers the opportunity to fulfill court-appointed community service requirements to individuals who can respect this mission and the staff who serve it. Please fill out this form, and a staff member will contact you to coordinate your hours.
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Phone number *
Mailing address *
Age *
How much can you routinely lift?
Number of hours appointed *
Service deadline *
Work Preference
Medical Conditions
Please list any medical conditions that might limit the activities you can participate in (e.g. allergic to poison ivy, exercise-induced asthma), or could require an emergency response (e.g. severe bee sting allergy, epilepsy). This information will only be shared with Trust staff for the purposes of delegating tasks and knowing how to intervene in case of an emergency.
Use the space below to add any information we should know (e.g. when you would like to start, days of the week you are typically available, etc.), or ask questions related to community service at PERT.
Emergency Contact Information *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy