Litter Control Program Application
|
|
- Aileen Morgan
- 6 years ago
- Views:
Transcription
1 Adopt A Road Litter Control Program Application Date of Application: Name of Organization or Group: Contact Person: Home Phone: Cell Phone: Mailing Address: Address: Are any volunteers younger than 18 years of age? Yes No (If yes, for every volunteer under 18 years old, fill out the Minor Participation Permission form. There must be 1 adult supervisor for every 6 minors on the day of the cleanup.) Approximate number of people participating in litter cleanup effort: Road segment organization or individual interested in adopting: Please application to: mgg@cityofmiltonga.us or fax: For information contact: Barbara Peck, Volunteer, Adopt-A-Road Coordinator , barbaraapeck27@gmail.com Teresa Stickels, Sustainability Coordinator, City of Milton , teresa.stickels@cityofmiltonga.us Adopt-A-Road Program Milton Grows Green City of Milton Deerfield Parkway, Suite 107 G Milton, GA Department Review Date: Approval #
2 Adopt A Road Litter Control Program Description The Adopt-A-Road program is administered by the Milton Grows Green Committee of the City of Milton. The program aims to help maintain the appearance of our city by holding routine clean ups (sweeps) of local streets. Any subdivision, club, organization, business, school, church, family or individual interested in performing community service and in helping to improve the appearance and quality of life in the City of Milton is encouraged to participate. The Adopt-A-Road program allows groups to adopt a minimum of one mile of roadway that has been designated for adoption by the city. The Adopt a Road set up process is as follows: Once the roadway has been identified and all forms filled out and ed or faxed to the Milton Grows Green Adopt-A-Road Coordinator, the group leader will set their first scheduled clean up date. Once the cleanup is scheduled and all safety rules have been reviewed, the group leader can pick up their Adopt-A-Road Safety Kit (safety vests, trash bags, etc), located at Milton City Hall Public Works Department Deerfield Parkway Suite 107G Milton GA After the first cleanup, the group leader will return the safety kit to the City of Milton Public Works Department. The Waiver/Completion form and the Recognition/Sign Request form should be ed to the Milton Grows Green Coordinator for processing at mgg@cityofmiltonga.us or faxed to Within approximately one month after submission of a sign request form, the City of Milton Public Works Department will install 2 Adopt-A-Road signs with the individual s or group s name at each end of the adopted roadway. This area must be adopted for a minimum of one year and a minimum of four cleanups should be performed each year. After twelve months, the group will have the opportunity to continue the adoption of the road if they have completed the required four sweeps. When the group decides it no longer wants to participate in the program, Milton Grows Green should be contacted so that the group or individual placard can be removed, and the road made available to other applicants. One of the goals of Milton Grows Green is to get the community involved in keeping our city a clean and safe place for citizens, visitors and businesses. With your help, we can make the City of Milton a better place to live, visit and work. For questions or if you would like to Adopt-A-Road, contact: Barbara Peck, Volunteer, Adopt-A-Road Coordinator, , barbaraapeck27@gmail.com
3 Adopt-A-Road Recognition/Sign Request Form The Milton Grows Green committee and the City of Milton Public Works Department will install Adopt-A-Road signs acknowledging your contribution to roadside litter reduction. (Please see the example to the right.) It will take approximately one month for the signs to be installed. There will be a maximum of 2 lines with 15 characters per line (includes spaces) for the name of the individual or organization adopting the road. Please complete the following: (Please print individual s or organization s name as you would like it to appear on the sign; using one or two lines, spaces do count as a character). Group Leader Telephone Number Address Adopted Road Segment Location A sign will be placed near each end of the adopted section. THANK YOU for your participation. *Please note that the signs are standard in size and color. Adjustments or additions to the design, including group or company logos, cannot be made. If you have questions please Barbara Peck, Volunteer, Adopt-A-Road Coordinator , barbaraapeck27@gmail.com
4 Adopt-A-Road Waiver/Completion Form Adopted Road Name Date of Clean up Group Leader Contact Phone Group Name Contact By signing below I certify that: I am participating and am under the control of our volunteer group and not the City of Milton. I understand and agree to abide by the Adopt-A-Road Safety Rules. I agree to release and forever discharge the City of Milton, its agents, employees and officials from any and all liability whatsoever for damages or injury resulting from my participation in this program. Volunteers are informed and acknowledge being advised that working adjacent to a roadway can be a hazardous activity which can cause bodily injury. Volunteers agree they will exercise due care and caution in performing litter pick up activities. Volunteers further acknowledge they have received safety instructions that include review of the Adopt-A-Road Rules prior to participating in any cleanup activities. Volunteers are to wear the safety vests furnished by the Public Works Department, and appropriate protective clothing during cleanup activities. Name (print) Signature Note: This form is required to be completed and returned after each cleanup. *Number of bags picked up Scan and your form to mgg@cityofmiltonga.us or fax to Were there any unusual incidents or injuries during the cleanup? If so, please describe.
5 (This form must be completed for each volunteer under 18 years of age prior to participation in the program and kept on file by the Volunteer Group Leader) Name of Participant: Volunteer Group: Address: Adopt-A-Road Minor Participation Permission Form City and State: Zip: Adopt-A-Road program allows volunteers young and old to contribute towards the effort to control litter and enhance roadside and neighborhood appearance. Volunteers are informed and acknowledge being advised that working adjacent to a roadway can be a hazardous activity that can cause bodily injury. Volunteers agree to exercise due care and caution in performing litter pick up activities. Volunteers further acknowledge they have received safety instructions that include review of the Adopt- A-Road Rules prior to participating in any cleanup activities. Volunteers are to wear the safety vest furnished by the Public Works Department, and appropriate protective clothing during cleanup activities. By signing below I certify that: I am participating and am under control of our volunteer group and not the city of Milton. I understand and agree to abide by the Adopt-A-Road Safety Rules. I agree to release and forever discharge the city of Milton, its agents, employees and officials from any and all liability whatsoever for damages or injury resulting from my participation in this program. Signed Print Child s Name Date Parent/Legal Guardian Permission and Assumption of Liability As parent/legal Guardian I, (print name) hereby grant my permission for the minor child named above to participate in the Adopt-A-Road program. I acknowledge, agree and understand that participation involves risks and inherent dangers that could cause injury and/or death. On behalf of myself and the minor child above I agree and release and forever discharge the city of Milton. Signed Date Emergency Medical Treatment Authorization As Parent/Legal Guardian of the above minor child volunteer I, authorize qualified emergency medical personnel, including a physician and staff, to examine the above named minor child, in the event of injury, and to administer emergency care and to arrange for any consultation by specialists, including a surgeon, as deemed prudent for proper care of any injury. Every effort will be made to contact the Parent/Legal Guardian prior to any treatment. Signed Date
6 Adopt-a-Road Safety Rules Volunteers in the Milton Grows Green ADOPT-A-ROAD program must comply with the following ADOPT-A-ROAD safety rules. The following list is not all inclusive and is not a substitute for common sense: volunteer group leaders and volunteers agree to make safety the first priority during ADOPT-A-ROAD cleanups. Wear the safety vest provided at all times. Be prepared for any unexpected behavior of motorists. Never assume a driver sees you. Clean only one side of the road at a time and walk facing oncoming traffic. Place the Volunteer Litter Crew Ahead warning sign facing traffic at the start of the section of roadway being cleaned. Do not stand or jump on guardrails, drainage pipes, or concrete walls. Never enter the roadway to pick up trash. Do not wear headphones or use a cell phone to text or call during a clean-up except for an emergency. Do not drink alcohol prior to or while participating in clean-up events. Do not handle hazardous materials such as car batteries, petroleum products and chemical spills, heavy or unwieldy objects, dead animals, broken glass, needles and drug paraphernalia, or any unidentified questionable items. Such items should be reported to the ADOPT-A-ROAD coordinator as soon as possible for proper disposal. Know emergency procedures and make sure someone has a cell phone in your group to dial in an emergency. Notify the volunteer group leader of all known allergies and any physical limitations prior to your participation. Avoid overexertion and heat-related problems by drinking water and taking breaks. Carpool to the litter pickup site and pull vehicles as far off the side of the road as possible. Vehicles should never be parked on the traveled portion of the roadway. Wear long sleeves, long pants, think-soled shoes or boots, and gloves. Perform cleanup activities only during daylight hours and when weather is conducive to good visibility. Avoid peak traffic hours and extreme inclement weather conditions. Stay clear of all construction areas. Avoid all horseplay of any nature. Do not distract drivers. Be careful of contact with poisonous plants, stinging insects, or stray/wild animals. Report all accidents or injuries to the volunteer group leader immediately. Tie orange trash bags securely and leave about 10ft. off the roadway for pick up by the City of Milton Public Works Department. Return your clean up kit and waiver/completion form to the City of Milton Public Works Department as soon as possible after each the clean up event. Should you experience an emergency, please dial 911 immediately. For non emergency questions, please call Barbara Peck, Volunteer Coordinator at , or barbaraapeck27@gmail.com Thank you for your help!
ADOPT - A - ROAD PROGRAM
LEONARDTOWN, MARYLAND ADOPT - A - ROAD PROGRAM Help Keep St. Mary s County Clean Adoption Date: October 20, 1998 Updated: February 2, 2015 POST OFFICE BOX 508 CALIFORNIA, MARYLAND 20619 Dear St. Mary s
More informationADOPT-A-ROADWAY VOLUNTEER GROUP INFORMATION PACKET
ADOPT-A-ROADWAY VOLUNTEER GROUP INFORMATION PACKET ADOPT-A-ROADWAY PROCEDURES FOR VOLUNTEER GROUP COORDINATOR Welcome to Smyrna s Adopt-A-Roadway program! This program gives you a way to show pride in
More informationCITY OF MORENO VALLEY PUBLIC WORKS DEPARTMENT MAINTENANCE AND OPERATIONS DIVISION ADOPT-A-ROAD VOLUNTEER PROGRAM APPLICATION MANUAL
CITY OF MORENO VALLEY PUBLIC WORKS DEPARTMENT MAINTENANCE AND OPERATIONS DIVISION ADOPT-A-ROAD VOLUNTEER PROGRAM APPLICATION MANUAL 1 Table of Contents ADOPT-A-ROAD PROGRAM SUMMARY... 3 PARTICIPANT RESPONSIBILITIES...
More information2017 Registration Form
2017 Registration Form For additional information, ple ase call City Service s at. Friday, April 21 st Registration Date: Must register by Tuesday, April 18 th. No late registration will be accepted. Submit
More informationAdopt-A- Road Group Application Form
Adopt-A- Road Group Application Form Type of Applicant: New Renewal Today s Date: Group Name: Group Leader Name: Mailing Address: Primary Phone Number: E-Mail Address: FAX Number: Preferred Method of Contact:
More informationBurleson's Great American Cleanup / Don't Mess with Texas Trash-Off
LITTER CLEANUP Burleson's Great American Cleanup / Don't Mess with Texas Trash-Off Burleson's Great American Cleanup / Don't Mess with Texas Trash-Off event is here! Cleanup activities will run from 9:00
More informationLitterRANGERS. Litter Cleanup Volunteer Program VOLUNTEER INFORMATION PACKET
LitterRANGERS Litter Cleanup Volunteer Program VOLUNTEER INFORMATION PACKET TABLE OF CONTENTS PROGRAM MISSION... 3 WHAT IS THE LitterRANGERS VOLUNTEER PROGRAM?... 3 WHO CAN PARTICIPATE?... 3 WHY PARTICIPATE?...
More informationADOPT-A-ROAD. Partners with Multnomah County. Multnomah County, Oregon Department of Community Services Land Use and Transportation Program
Multnomah County, Oregon Department of Community Services Land Use and Transportation Program May 2011 Table of Contents 1/1 Table of Contents: The Adopt-A-Road Packet Page 2 How do I use this packet?
More informationABC Young Professionals Volunteer Day
ABC Young Professionals Volunteer Day Spend time with other Young Professionals and help to maintain one of Denver s beautiful parks! Saturday, September 23rd 9:00 am - 12:00 pm Bear Valley Park (W Dartmouth
More informationUniversity Health Services and Safety. Occupational Health & Safety Guideline
Advisory 21.0 Persons under 18 years of age are not allowed in laboratories where hazardous substances (chemicals, biologicals, etc.) are present or physical hazards (very hot or cold temperatures, laser
More informationAnnual 2-hour Clean Up Blitz Invitation
Annual 2-hour Clean Up Blitz Invitation Show your community pride and participate in a 2-hour Clean Up Blitz from 9 a.m. to 11 a.m. on Saturday, May 5 th, 2018. Participants are asked to spend 2 hours
More informationCounselor Application 2018 July 9 th 13 th
Counselor Application 2018 July 9 th 13 th Name Address City State & Zip Home Phone Cell Phone E-mail address Male Female Birth Date (mm/dd/yy) Age (at camp) Emergency Contact Name Phone Relation to Camper
More informationThe Alaska Youth Academy Application
The Alaska Youth Academy Application Email to katina.charles@tananachiefs.org by June 30 th, 2016 Personal Information Please write in or circle your answer. Name: (First) (Middle) (Last ) Date of Birth
More informationCity of Fort Worth, Texas Community Emergency Response Team (CERT) Standard Operating Procedures
City of Fort Worth, Texas Community Emergency Response Team (CERT) Program Contact: Officer Phil Woodward CERT Coordinator, Fort Worth Police Department 505 W Felix St, Fort Worth, TX 76115 Office 817-392-4115,
More informationSummer Engineering Academy
TM February 5, 2018 Aloha, Honolulu Community College is once again pleased to announce its upcoming Summer Engineering Academy. Space will be limited, so please apply as soon as possible. Only 60 students
More informationADOPT-A-TRAIL APPLICATION
ADOPT-A-TRAIL APPLICATION INTRODUCTION RIVERSIDE COUNTY REGIONAL PARK & OPEN-SPACE DISTRICT ADOPT-A-TRAIL PROGRAM The Adopt-A-Trail (AAT) program was developed by the Riverside County Regional Park & Open-Space
More informationINTERNATIONAL COASTAL CLEANUP September 19, 2015 Site Coordinator Registration Form
The International Coastal Cleanup (ICC) is a global initiative led by The Ocean Conservancy. This cleanup event has taken place across the globe for the past 30 years. Last year, 684,015 volunteers joined
More informationBiology 100, 101, 102, 105 Laboratory Safety Agreement
Biology 100, 101, 102, 105 Laboratory Safety Agreement In the interest of safety and accident-prevention, there are regulations to be followed by all credit students in designated science laboratory rooms
More informationFLAT ROCK WARRIORS FOOTBALL REGISTRATION
FLAT ROCK WARRIORS FOOTBALL REGISTRATION Player Information: Name: (Last, First, Initial) Address: (Street, City, Zip) Mother s Name: Email: Home Phone: Work Phone: Cell Phone: Father s Name: Email: Home
More informationJunior Volunteer Program
5126 Hospital Drive Covington, GA 30014 Tel: 770.788.6553 Andrea.Lane@piedmont.org Junior Volunteer Program Information Packet Piedmont Newton Hospital Volunteer Services Summer 2016 June 13 July 22 1
More informationGeneral Information & Preparation
Ponderosa Retreat Parent Information Please Keep This Information Paper for your Reference All Other Forms, with $50 Payment, Turn-in by Friday, August 17 All Other Forms Must be Signed to be Valid General
More informationCrisis Management Manual. Bodine School 2432 Yester Oaks Drive Germantown, TN /7/2017
Crisis Management Manual Bodine School 2432 Yester Oaks Drive Germantown, TN 38139 901-754-1800 www.bodineschool.org 6/7/2017 Table of Contents Emergency Phone Numbers... 3 Communication... 4 Communication
More informationUnder no circumstance shall a supervisor assign an employee to work without the protective equipment furnished to him to assure his personal safety.
Employees Personal Protection The City offers a variety of safety devices and protective equipment for the employees personal protection. It is the supervisor s responsibility to evaluate job tasks to
More informationEQUINE PROGRAM SUMMER VOLUNTEER APPLICATION HOME PHONE: T-SHIRT SIZE (circle one): SMALL MEDIUM LARGE X-LARGE XX-LARGE
EQUINE PROGRAM SUMMER VOLUNTEER APPLICATION VOLUNTEER NAME: BIRTH DATE: / / MAILING ADDRESS: CITY: STATE: ZIP: CELL PHONE: HOME PHONE: EMIAL ADDRESS: T-SHIRT SIZE (circle one): SMALL MEDIUM LARGE X-LARGE
More informationWe ll meet in the Youth Room at 2:30 p.m. and we ll return by 6:30 p.m. (depending on traffic)! For students in grades 7-12.
For I was hungry and your gave me food, I was thirsty and you gave me something to drink, I was a stranger and you welcomed me. Matthew 25:35 The Dallas Life Foundation is a Christian based homeless shelter
More informationState of North Carolina Department of Correction Division of Prisons
State of North Carolina Department of Correction Division of Prisons POLICY AND PROCEDURE Chapter: D Section:.0700 Title: Issue Date: 11/22/05 Supersedes: 05/08/02 Inmate Labor for Public Work Projects.0701
More informationNORTH CAROLINA 4-H VOLUNTEER APPLICATION
NORTH CAROLINA 4-H VOLUNTEER APPLICATION PERSONAL INFORMATION First Name: Middle Name: Last Name: Suffix: Preferred Name: Mailing Address: Mailing Address 2: City: State: Zip: Gender: Male Years in 4-H:
More informationThe Alaska Youth Academy Application
The Alaska Youth Academy Application Email to katina.charles@tananachiefs.org by June 26 th, 2015 Personal Information Please write in or circle your answer. Name: (First) (Middle) (Last ) Date of Birth
More informationCOMMUNITY, COUNSELING & CORRECTIONAL SERVICES, INC. Gallatin County Re-Entry Program SPONSOR FORM
COMMUNITY, COUNSELING & CORRECTIONAL SERVICES, INC. Gallatin County Re-Entry Program SPONSOR FORM Name of Resident Being Sponsored: Name of Sponsor Applicant: Community passes are one of the most important
More informationHelping others grow and excel through their interaction with horses 3498 Barclay Messerly Road Southington, Ohio 44470
Dear Prospective Volunteer: Helping others grow and excel through their interaction with horses 3498 Barclay Messerly Road Southington, Ohio 44470 Ph. (330) 889-0036 www.thecamelotcenter.org ==============================================================
More informationAuburn University Marching Honor Band 132 Goodwin Music Building Auburn University, AL
Congratulations! Based on your application and your director s recommendation, you have been selected to participate in the Fourteenth Annual Auburn University Marching Honor Band, sponsored by Auburn
More informationSchool Excursions and Incursions Policy
School Excursions and Incursions Policy 1.1 Introduction An is defined as an activity organised by the school whereby students leave the school grounds to engage in educational activities. An incursion
More informationIntroduction to Southern Baptist Disaster Relief in Tennessee
Introduction to Southern Baptist Disaster Relief in Tennessee Why should we help people in a time of disaster? Southern Baptist Disaster Relief is, meeting the urgent needs of hurting humanity in crisis
More informationUnion County Community Service Program Information Packet
Union County Community Service Program Information Packet Community Service Coordinator: Caitlin Bower Phone: 570-524-3846 Email: cbower@unionco.org Fax: 570-768-4779 General Rules When designated to perform
More informationEastern Treatment Plant (ETP) Venue and Safety Information
Eastern Treatment Plant (ETP) Venue and Safety Information Please complete the following important actions in preparation for your tour: Read and pass on the below information to all ETP tour participants.
More informationHealth & Safety School Tour Risk Assessment and Management Plan
Mary Cairncross Scenic Reserve at Maleny, Maroochy Bushland Botanic Garden at Tanawha and Maroochy Wetlands Sanctuary at Bli Bli are the three key bushland reserves which form the Centres for Conservation,
More informationWELCOME TO RON RUSSELL SUN COMMUNITY SCHOOL! Like us on Facebook:
WELCOME TO RON RUSSELL SUN COMMUNITY SCHOOL! Like us on Facebook: www.facebook.com/sunronrussellms SUN Extended Day Schedule: 3pm - 3:17pm: Free Meal 3:20pm - 4:10pm: Period 1 4:15pm - 5:20pm: Period 2
More informationTo begin the application process, please complete the enclosed application and bring it with you to one of our weekly meetings.
Dear Explorer Applicant, We are pleased that you have shown interest in the Miramar Police Department Explorer Program. The Explorer program is the best program that young men and women can become involved
More informationYouth in Philanthropy STUDENT APPLICATION
2014-2015 Youth in Philanthropy STUDENT APPLICATION The application deadline is September 22, 2014. Please keep in mind applications that are incomplete and/or received after the deadline will not be considered.
More informationMarch 3, Dear Team Captain,
March 3, 2008 Dear Team Captain, Welcome to the 17 th annual 24 Hour Relay Challenge scheduled for Memorial Day weekend, May 24-25, 2008, on Holt Field at San Luis Obispo High School. This packet is intended
More informationBack-to-School Forms
2017-18 Back-to-School Forms JrK Please complete all included forms and submit to the front desk. Scheduled paperwork turn in times are as follows: July 17 through 21st, between 8am-5pm: Last names A-M
More informationPlease Print Affiliation (school, company name, etc): Mailing Address: City: Postal Code: Home Phone: Cell Phone: Work: Date of Birth (DD/MM/YY):
Name: Volunteer Application Thank you for your interest in volunteering with Habitat for Humanity Wellington Dufferin Guelph. The information you provide will help us to place you in a volunteer position
More informationChild Health and Safety
1. Responding to Emergency Staff will be trained on emergency procedures such as but not limited to CPR, basic first aid, and medication administration. Emergency procedures will be posted in classrooms.
More informationAugsburg University, Minneapolis
Augsburg University, Minneapolis Who? NLC 9th grade confirmands and friends! What? Urban Plunge! Urban Plunge is an awesome overnight Augsburg student-led, faith-based experience for Middle and High School
More informationINDIANA UNIVERSITY GLOBAL GATEWAY FOR TEACHERS REGISTRATION FOR OVERSEAS STUDENT TEACHING
INDIANA UNIVERSITY GLOBAL GATEWAY FOR TEACHERS REGISTRATION FOR OVERSEAS STUDENT TEACHING 1 - Placement Information Sheet Record all dates as month (spell out), day, and year. First and last name: Birth
More informationEmergency Response For Schools
Emergency Response For Schools A resource to help School Administrator s manage the first 30 minutes during an emergency. to Chignecto Central Regional Centre for Education 1 Emergency Response for Schools
More informationCOMPEER PROGRAM VOLUNTEER APPLICATION
Spreading Hope, Spurring Action, Supporting Families, Saving Lives! COMPEER PROGRAM VOLUNTEER APPLICATION 3701 Latrobe Drive, Suite 140 Charlotte, NC 28211 Phone 704.365.3454 Fax 704.365.9973 Revised 7/13/2017
More informationNorthside Baptist Church FAMILY LIFE CENTER POLICIES & PROCEDURES
PARTICIPATION Northside Baptist Church FAMILY LIFE CENTER POLICIES & PROCEDURES The FLC is available to all church members during the posted hours of operation. Continued use depends upon the individual
More informationReturning Volunteer Application
Returning Volunteer Application Office Use Only Application Received Brenda LeBlanc, Volunteer Coordinator 978-683-4000 x2645 Brenda.leblanc@lawrencegeneral.org Welcome! Returning Volunteers, Before returning,
More informationDivision of Early Care and Education. Child Care Emergency Plan Template for Exempt Providers
Division of Early Care and Education Child Care Emergency Plan Template for Exempt Providers Federal law requires child care facilities that receive federal funds to have a plan in place that addresses
More informationDISTRICT 205 STUDENTS ARE FREE
The Rockford Area Arts Council offers RAAC Camp for students ages 5-13. Students will participate in three classes per day and present a performance and art exhibit for family and friends on Thursday,
More information11th Annual Conyers Car Show in conjunction with The Taste of Conyers May 5, 2018
11th Annual Conyers Car Show in conjunction with The Taste of Conyers May 5, 2018 Dear Prospective Participant, Redline Event Production and the City of Conyers invite you to the 11th Annual Conyers Car
More informationPOSITION DESCRIPTION
POSITION DESCRIPTION TITLE OF POSITION: Seasonal/Limited Term Employee Parks Caretaker IMMEDIATE SUPERVISOR: Director of Facilities & Grounds EFFECTIVE DATE: April, 2014 GENERAL PURPOSE: The Caretaker
More informationResponse Team Volunteer Application
Thank you for your interest in volunteering. The ASPCA Response Team is a group of specially trained staff members and volunteers who respond to man-made and natural disasters throughout the country. Please
More informationKairos Retreat Policies & Permission Forms Bring home to Parents TODAY!
Kairos Retreat Policies & Permission Forms Bring home to Parents TODAY! ***Please Read All Information Carefully**** Complete & return all forms (retain first and back page) to the Reception Desk Main
More informationCARSON CITY VOLUNTEER/INTERN APPLICATION. Volunteer/Intern Name: City, State, Zip: Day Phone: Night Phone: Cell Phone:
CARSON CITY VOLUNTEER/INTERN APPLICATION Date: Volunteer/Intern Name: Home Address: City, State, Zip: Day Phone: Night Phone: Cell Phone: E-mail: Occupation: Business Name: Phone: Are you under the age
More informationHomebound Health and Disaster Planning
ALL ABOUT ME First Responders See Back Cover My Name: What I Need You to Know What is the best way to communicate with me? What objects MUST leave with me? (Service animal, medications, mobility walker?)
More informationRegistration Form Parent/Guardian Information:
Registration Paid $ Entered by: Payment : Initial Visit: Registration Form How did you hear about us? Parent #1 Parent/Guardian Information: First & Last name: Drivers License# Family Password Address
More information2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION
2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION Law Enforcement agencies from across Marshall County will sponsor and provide a Law Enforcement Youth Camp for students this year on the dates
More informationCamp TOV Medical Form
Mail: Fax: Please send these forms to us by either: Jewish United Fund/Jewish Federation of Metropolitan Chicago Attn: Camp TOV 30 South Wells Street, Room 5034 Chicago, IL 60606 Attn: Camp TOV 312-444-2086
More informationMichigan State University Department of Chemical Engineering and Materials Science (CHEMS) SAFETY Documents
Michigan State University Department of Chemical Engineering and Materials Science (CHEMS) SAFETY Documents Contents Safety Training Requirements 2 Safety Compliance Guidelines 3 Laboratory Safety Rules
More information2 SESSIONS!!! Sign up for one OR both!
ARTS Camp for 5-13 year olds!!! Campers choose THREE classes: Art, Hip-Hop Dance, Modern Dance, Theater, Video, Singing, Rap, Creative Writing, and Guitar (for 10 and up). There is an Art Exhibit & Performance
More informationSee Bulk Trash Information and Schedule below.
Getting Started: Comments 1. Form a committee of community members to take the lead in organizing the event. Determine your goal for the event, and the issues you want to focus on (for example: neighborhood
More informationFAMILY DISASTER PLAN. Name: Date: 4 STEPS OF SAFETY LOCAL OFFICE:
FAMILY DISASTER PLAN Name: Date: It is recommended that every employee of the judicial branch have a personalized Family Disaster Plan. Families can - and do - cope with disaster by preparing in advance
More informationJunior Baseball Spring 2017 Ages 8 & 9
ACTIVITY NUMBER: 10402 Department of Parks & Recreation Recreation Division 101 Field Point Road - Greenwich, CT 06836-2540 Phone: (203) 618-7649 Email: Recreation@greenwichct.org Junior Baseball Spring
More informationTerrorism. What You Can Do to Prepare
Terrorism Devastating acts, such as the terrorist attacks on the World Trade Center and the Pentagon, have left many concerned about the possibility of future incidents in the United States and their potential
More informationNATIONAL LEADERSHIP CONFERENCE RUN4RED 5K WALK/RUN WAIVER
RUN4RED 5K WALK/RUN WAIVER I understand that participation in the Run4Red 5K Walk/Run presents certain risks and hazards, including, but not limited to: muscle strains and sprains, bruises, broken limbs,
More informationWritten applications for admission are accepted year round and qualified applicants will be placed in appropriate class.
835 Ferry Street Martinez CA 94553 925-293-4792 Loaves and Fishes of Contra Costa ( LFCC ) Culinary Training Program ( CTP ) The Loaves and Fishes Culinary Training Program is a five-week (@70-100 hours)
More informationMailing Address: Work Phone: City, State, Zip: Cell Phone: Age: Sex: address:
WILLIAMSPORT DISTRICT SUSQUEHANNA CONFERENCE UNITED METHODIST CHURCH VOLUNTEERS IN MISSION Team Member Application The mission trip team leader will not share this information except as required and related
More informationCENTERFORRESEARCH VOLUNTEERFORM
CENTERFORRESEARCH VOLUNTEERFORM CENTER FOR RESEARCH VOLUNTEERS PARTICIPATING IN ACTIVITIES IN RESEARCH LABORATORIES REGISTRATION FORM This form should be completed by and for all adult volunteers (i.e.,
More informationAuburn University Marching Honor Band 132 Goodwin Music Building Auburn University, AL
Congratulations! Based on your application and your director s nomination, you have been selected to participate in the Tenth Annual Auburn University Marching Honor Band, sponsored by Auburn University
More informationSTUDENT MINISTRY GUIDELINES AND FORMS
STUDENT MINISTRY GUIDELINES AND FORMS Table Of Contents TRAVEL GUIDELINES FOR: Camps ~ Retreats ~ Overnight Transportation Restaurants EMERGENCIES: Emergency Procedures Medical Emergency Procedures LEADERSHIP:
More informationINDIANA UNIVERSITY GLOBAL GATEWAY FOR TEACHERS. Tips for the Registration Set (December 2017)
INDIANA UNIVERSITY GLOBAL GATEWAY FOR TEACHERS Tips for the Registration Set (December 2017) NOTES: These tips do not replace a thorough reading of the Global Gateway Program Booklet! Before you prepare
More informationSCHOOL DISTRICT 2 KEEPING OUR SCHOOL SAFE
SCHOOL DISTRICT 2 KEEPING OUR SCHOOL SAFE SCHOOL: PRINCIPAL: DATE: SCHOOL DISTRICT 2 KEEPING OUR SCHOOLS SAFE Table of Contents 1. Keeping our Schools Safe -Checklist for Administrators 2. Emergency Kit
More informationPEGASUS THERAPEUTIC RIDING ACADEMY SENIOR SADDLES PROGRAM PARTICIPANT REGISTRATION FORM DATE: Name Date of Birth Ht. Wt. Home Phone Cell Phone
PEGASUS THERAPEUTIC RIDING ACADEMY SENIOR SADDLES PROGRAM PARTICIPANT REGISTRATION FORM DATE: Name Date of Birth Ht. Wt. Home Phone Cell Phone Address City State Zip E-mail address Race/Ethnicity: Caucasian
More informationEXECUTIVE MEMBERSHIP APPLICATION AND AGREEMENT
EXECUTIVE MEMBERSHIP APPLICATION AND AGREEMENT Please provide the following information (please print legibly): MEMBER: Last Name: First Name: _Middle Name: Address: _ Home Telephone Number: Work: Cell:
More informationThe Head of Lower School will be responsible for the implementation of this policy.
EDUCATIONAL VISITS EYFS Guidance The Head of Lower School will be responsible for the implementation of this policy. Learning outside the classroom environment is an essential part of our curriculum. Trips
More informationCamp Hero Registration 2017
Camp Hero Registration 2017 Camp Hero my child will be attending: June 5 9 (Joint Base Pearl Harbor Hickam location) June 26 30 (Marine Corps Base Hawaii location) I would like to register for the Extended
More informationCourt Referral Program YDAD REGISTRATION
Court Referral Program YDAD REGISTRATION Case Number# : Name: (First) (Middle Name) (Last Name) Address: City: State: Zip: Home Phone: ( ) Cell: ( ) Work Phone: ( ) Fax #: ( ) Email Address: @. Social
More informationVacation Bible School
1 Vacation Bible School Be Prepared, Be Protected A Checklist for a Great Summer Program! To operate a safe, fun and effective Vacation Bible School, safety must be your primary consideration. To do this,
More informationMichael Jordan. Questions? Please contact: Director of Youth Ministry. Phone: x230
What: Youth will travel to Idaho to partner with Idaho Servant Adventures, a ministry of Lutherhaven. During this servant-leadership camp, we will work alongside other youth groups repairing and transforming
More information2017 Summer Camp Registration
1515 N. Galloway Avenue Mesquite, Texas 75150 972.216.6260 www.cityofmesquite.com 2017 Summer Camp Registration Please select which camp your child(ren) will be attending BLAST Camp Sports Camp Teen Camp
More informationDivision of Early Care and Education. Child Care Emergency Plan Template
Division of Early Care and Education Child Care Emergency Plan Template South Carolina Department of Social Services regulations require child care facilities to have a plan in place that addresses emergency
More informationSENIOR FOOD PRODUCTION UTILITY WORKER
PERSONNEL COMMISSION SENIOR FOOD PRODUCTION UTILITY WORKER Class Code: 0478 Salary Range: 19 (C1) JOB SUMMARY Under general supervision, lead a small crew and perform a variety of general grounds maintenance
More informationFacilities Department Accident Prevention Plan
Prepared By: Facilities Management team Revision Date: 2/12/18 1.0. PURPOSE The management of Edmonds Community College is committed to preventing accidents and ensuring the safety and health of our employees.
More informationThank you for your interest in the Yorba Linda Public Library Children's Services Summer Volunteer Program!
Thank you for your interest in the Yorba Linda Public Library Children's Services Summer Volunteer Program! The Children's Services summer volunteer program provides positive and fun community service
More informationNicaragua Mission Trip: April 15-24, 2016
American Baptist Churches of New York State & American Baptist Churches of Pennsylvania and Delaware Nicaragua Mission Trip: April 15-24, 2016 Part 1: Mission Trip Application: Cost: $1,750 Please Make
More information4-H Shooting Sports Instructor
Training 4-H Shooting Sports Instructor Certification Training for 4-H Certified Adult Volunteers in the 4-H Shooting Sports Program Date: May 27-28, 2016 Location: Cost: State 4-H Office and Stillwater
More informationMELBOURNE POLICE DEPARTMENT GENERAL ORDERS
TITLE: MELBOURNE POLICE DEPARTMENT GENERAL ORDERS MPD POLICY #: H.702 CFLEA #: 17.07M EFFECTIVE DATE: 07/01/00 POLICY AND PROCEDURE DIRECTIVE VEHICULAR PURSUITS SUPERSEDES: G.O. 702 (06/01/92) ATTACHMENTS:
More informationGetting Prepared to be a Volunteer at a Disaster Participant Guide
Getting Prepared to be a Volunteer at a Disaster Participant Guide Copyright 2017 Midwest Consortium for Hazardous Waste Worker Training Acknowledgments The Midwest Consortium (MWC) developed this introduction
More informationFriday, June 22 through Monday, June 25, 2018 between 4 and 5 pm 1 pm close-toed shoes (No flip flops or sandals during the weekend)
Dear Student, Congratulations! You have been selected and awarded a scholarship to participate in Rotary District 5470 s RYLA 2018 Leadership Retreat because Rotarians in your community have identified
More informationVolunteer/Staff Information Form and Health History General Information
Volunteer/Staff Information Form and Health History General Information Name: Date of Birth: Date: Local Address: Street: City: Summer Address: Street: State: Zip: State: Zip: Phone: City: Local Phone:
More informationMESA COMMUNITY COLLEGE. Information Packet 2018 YOUTH COLLEGE. Workshop I & II - Please fill out the following forms and bring to your Audition Time:
MESA COMMUNITY COLLEGE Information Packet 2018 YOUTH COLLEGE Workshop I & II - Please fill out the following forms and bring to your Audition Time: o 14 years and older Need to provide picture ID for Student
More informationLompoc Police Department Explorer Post #700
Lompoc Police Department Explorer Post #700 APPPPLIICATIION FOR MEMBERSSHIIPP Print legibly all information required and answer all questions as completely and truthfully as possible. After filling out
More informationSeeker Springs. Ministry Center. Challenge Course Booking Information Sheet. City: State: Zip: Phone: Cell Phone: Fax:
Seeker Springs Group Name: Event Name: Contact Person: Address: Ministry Center Challenge Course Booking Information Sheet City: State: Zip: Email: Phone: Cell Phone: Fax: Arrival : Estimated # of People:
More information2016 Multi-Jurisdictional Law Enforcement Explorer Academy
2016 Multi-Jurisdictional Law Enforcement Explorer Academy All questions must be answered. If something does not apply please indicate N/A. Note: If there are any un-answered questions on this application
More informationEmergency Preparedness BSA
Emergency Preparedness BSA The United States Department of Homeland Security (DHS) is pleased to partner with the Boy Scouts of America to increase the level of citizen preparedness across the country.
More informationBig Sandy Fire Protection District/Simla Volunteer Fire Department Junior Firefighter Program Guidelines
Big Sandy Fire Protection District/Simla Volunteer Fire Department Junior Firefighter Program Guidelines The Junior Firefighter Program was instituted by the Big Sandy Fire Protection District (Big Sandy
More informationTHIRD PARTY RIDE-A-LONG PROGRAM
General Conduct The conduct of a rider will reflect upon the individual, the responding agency, other cooperating agencies and the program in which the rider is associated with. Each rider is required
More informationReady? Is Your. Family. Dear neighbors,
Is Your Ready? Family Dear neighbors, It s impossible to predict where you or your family will be when a disaster strikes. You could be confined to your home or forced to evacuate. Local officials will
More information