LSCC KC Volunteer Registration-Clermont 2015 - Lake

Clermont KIDS’ COLLEGE
Volunteer Community Service Registration
Application Deadline: May 15, 2015
No applications will be accepted after this date or at the mandatory meeting.
When you hit submit after completing the application, you will receive an email confirmation reminding you of the mandatory
meeting. If you do not receive the email confirmation, you will need to try saving the application to your desk top, attach it to an
email and send it to: KC@lssc.edu. If you still don’t receive the confirmation email, it is your responsibility to mail your application to
the address at the bottom right. If we don’t receive your application, you will not be on the list, you will not be allowed to stay for the
meeting and you will not be able to volunteer. Make sure the application you send to us is not blank - check it before sending.
Last Name (print clearly)
First Name
Mailing Address
Nickname for name tag
City
/
Grade next year
/
Cell Phone
Zip
High School You Attend (your hours will be sent to this school)
Email
Home Phone
Emergency Contact Name
Emergency Contact Phone
If you will be 18 on or before July 23, 2015 you will have to shedule a background check with
Lake-Sumter State College, Leesburg Campus. Call (352) 365-3557 to schedule an appointment.
Date of Birth
Select the Program, morning, afternoon or both in which you wish to volunteer. You can volunteer for as many programs/sessions as you wish as long
as you can be there all 8 days. Do not sign up for a program in which you cannot fulfill all 8 days in that particular program. Place an X in the
box next to all the session(s) in which you wish to volunteer.
(P1)Program 1 (8 days) June 15 - June 25
8:00 AM1:00 PM
Mornings
11:45 PM4:45 PM
Afternoons
8 Days (40 hours)
and/or
8 Days (40 hours)
(P2)Program 2 (8 days) June 29- July 9 (P3)Program 3 (8 days) July 13 - July 23
Both AM/PM
All Day
8:00 AM1:00 PM
Mornings
72 hours
8-5 p.m.
11:45 PM4:45 PM
Afternoons
Mornings
Both AM/PM 8:00 AMAll Day 1:00 PM
8 Days (40 hours)
and/or
8 Days (40 hours)
72 hours
8-5 p.m.
8 Days (40 hours)
and/or
Both AM/PM
All Day
Afternoons
11:45 PM4:45 PM
8 Days (40 hours)
72 hours
8-5 p.m.
You may be assigned to indoor/outdoor class dependent on schedule. Select multiple areas of interest in which you would be willing to
volunteer. Program offered is next to subject but not all classes are offered am and pm so it is important that you list multiple areas of
interest. We will place you where you are most needed but will try to take your interest into consideration.
Performance
Sports (indoors)
acting P1,P2,P3
improvisation P2
kids on stage P2,P3
make it up (makeup)
musical theatre P2,P3
project runway P1
baton P1,P2
dance P1,P2,P3
music P1,P2,P3
P1
Sports (outdoors)
band, Instrumental P1,P2,P3
guitar P1,P2
party all the time P3
singing P1/Glee P3
song writing P1,P2,P3
percussion/sch rock P3
amazing race/olympic fun
archery P2,P3
flag football P1,P2,P3
handball P1
frizbee P1,P2,P3
frizbee disc golf P2
soccer P1,P2,P3
softball P3
tennis P1,P2,P3
Arts & Crafts
art P1,P2,P3
art/ceramics P1,P2,P3
crafts, P1,P2,P3
fashion design P2
Home Economics
STEM
angry birds P1,P2,P3
basketball P1,P2,P3
board games P1,P2,P3
cheerleading P1,P2,P3
lets play ball P1,P2,P3
Nintendo DS battle P1,P2,P3
rockin fitness P1
self defense P1,P2,P3
volleyball in/outdoors P1,P2,P3
P2
astronomy/rockets P1,P2
bugs, bugs, bugs P3
build mini golf course P1,P3
chemical attraction P3
chemistry lab P1,P2
engineering P1,P2,P3
robotics P3
math/stats/trash can baseball
mathematical art P1
money/finance P1
oceanography and sharks P1
science P2,P3
babysitting P3
cooking P1,P2,P3
gardening - after care
Books, Reading, Writing
ABC for teens P1,P2
creative writing P1,P2,P3
kids news P1,P3
leadership P1,P2,P3
magic P2,P3
reading
ancient world P1,P2,P3
Harry Potter P2,P3
Origami Yoda P3
Star Trek P3
mystery P1,P2,P3
P1,P2,P3
Miscellaneous
balloon bonanza P3
during late care 4-5 KC talent P1,P2
during late care 4-5 earth works P3
(gardening)
Office
Would you be willing
to work in the office?
Please list from your choices above your 1st, 2nd, 3rd, 4th & 5th choice in order of preference, 1 being most important, 5 least important.
1.
2.
5.
4.
3.
Please list on the line below any limitations you have that we need to be aware of:
By typing my name on the signature line below, I agree to attend the mandatory training session at 2:30 on June 10, 2015 at East Ridge Middle
School, Clermont and I agree to commit to at least a two-week session. I will always report to work on time, exhibiting a good attitude and
will be a positive role model to Kids’ College participants. I will actively interact with participants while maintaining a safe atmosphere. I
understand that if I fail to adhere to these requirements, I may be dismissed from the program.
Signature
Date
Name on card
City
State
Office Use Only
Receipt No.
Visa
American Express
Mastercard
Discover
Card Number
Billing Mailing Address
Zip
$ 25.00
3 Digit
Security Code
Expiration Date
Amount Non-Refundable
Leadership Training
Paid By
Receipt Date
Cashier Initials
P3
Continuing Education
9501 U.S. Highway 441 Leesburg, FL 34788
(352) 365-3556