# of
Volunteers needed & on what days: Max.:
___ Min.: ___
(Circle one day or both)
Fri., Sept. 14 Sat., Sept. 15
Skilled or specialized labor that may be needed: ____________________________________________
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Volunteer Activity Description
Describe the 4 Hour project to be completed by
volunteers:
(include specifics, i.e. agency’s goal, any plans for bad
weather, etc.)
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___________________________________________________________________________________
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Supplies/Equipment
The agency is responsible for securing supplies and equipment
for these projects. In some cases, companies may be able to assist
you with purchases. If assistance is needed in obtaining
equipment, please describe on an attachment.
Yes No
Does your organization have liability insurance that would cover
this event?
Yes No
If not, please contact your insurance carrier.
___________________________________________________________________________
Agency Director Signature
Title
Date
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