U-Connect Application Form 2012,2013
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Transcript of U-Connect Application Form 2012,2013
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U-Connect Crew 2012-2013 Member Application Form
Generating Ideas, Connections, and Community
U-Connect Crew Member Contact Information
Full Legal Name
Address
Date of Birth (yyyy/mm/dd) Age Grade Youth Volunteerunder the age of 18
City Province Postal Code Home Phone
Cell Phone Email How did you hear about RYSA?
U-Connect Crew Member Crew Interest
*Please choose only 1 Crew & note that we will do group projects together*
U-Write Crew write articles online U-Do Crew does community projects
Term 2 February 2013 May 2013 [ ] Term 2 February 2013 May 2013 [ ]
Comments:
Getting to know you1. What makes you interested in becoming a U-Connect Crew member?
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To register: Please email form [email protected] drop off complete form inperson at the centre with Kim either in the morning between 9-11AM or afternoon
between 3-5PM at #100-7900 Alderbridge Way.
***We do not accept faxed OR incomplete applications***
Parental/Guardian Consent section (Necessary if the volunteer is under the age of 18)
I, ____________________________, hereby authorize, ______________________, to participate involunteer activities Richmond Youth Service Agency (RYSA). By signing this form I am stating that I am
their legal guardian/parent and I understand that participation in RYSA volunteer activities might involvetravelling with RYSA staff and come in close contact with public. I authorize to consent to their participationand I have provided accurate information and disclosed all relevant medical details, and any otherinformation that may impact participation and supervision that is required of my child.
By signing this form I agree I have ful l read the form s, requirements and HEREBY RELEASE AND
FOREVER DISCHARGE both Richmond Youth Service Agency , its employees, directors or agents
of and from all manner of actions, causes of actions, claims and demands of w hatsoever nature
wh ich my chi ld/ward may have in respect of any injury, loss or expense he/she may sustain aris ing
out of or in any way connect with h is/her part ic ipation in this prog ram.
Name of the parent/guardian(print clearly)
Signature Date
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mailto:[email protected]:[email protected]:[email protected]:[email protected]
