P.O.P.S Application

 

Name

 

_____________________________

Address

 

_____________________________

 

_____________________________

 

Phone

_____________________________

 

Cell Phone

_____________________________

 

E-Mail

_____________________________

 

Student’s Names and Grades

 

_____________________________

 

_____________________________

 

_____________________________

 

Emergency contact: Name and phone #

 

_____________________________

 

Preferred days to

volunteer (circle)

 

Monday

Tuesday

Wednesday

Thursday

 Friday

 

AM ______ PM________

 

 

Are you available to volunteer on early release days?

 

 

Yes (    )  No (    )