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Leesburg KIDS’ COLLEGE
Volunteer Community Service Registration
Application Deadline: May 15, 2015
No applications will be accepted after this date or at the mandatory meeting/training.
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 to: [email protected]. 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.
First Name
Last Name (print clearly)
Nickname for name tag
Mailing Address
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
(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
8 Days (40 hours)
Both AM/PM 8:00 AMAll Day 1:00 PM
Mornings
8 Days (40 hours)
and/or
8 Days (40 hours)
72 hours
8-5 p.m.
8 Days (40 hours)
Both AM/PM
All Day
and/or
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)
STEM and Miscellaneous
Books, Reading, Writing
acting P1,P2,P3
bugs & beyond P1,P2,P3
basketball P1,P2,P3
make up P2,P3
build mini golf course P2
board games P2,P3
musical theatre P1
engineering great challenge P2
chess P2,P3
project runway P2
Japanese culture P3
cheerleading P1,P2
baton P1,P2,P3
legos P1,P2
lets play ball P1,P2,P3
dance P1,P2,P3
money/finance/math P2,P3
Nintendo DS battle P1,P2
music P1,P2,P3
ocean life/aquatics P1,P2
Sports (outdoors)
glee P1,P2
sea turtles/sharks/environ. P1,P2,P3
guitar P3
robotics P2
archery P1
sing America P2
science P1,P3
barrell ball P3
show choir P3
space/myth busters/rockets P1,P2
flag football P1,P2,P3
party all The time P1,P2
stranded/treas. map/obstacles P2,P3
outdoorsmanship P1,P2,P3
percussion,sch/rock P1,P2
pickle ball P1,P2
Computers
soccer P1,P2
Arts & Crafts
tennis P1,P2,P3
computer digital creator/writing P3
volleyball P2,P3
art/neon painting P3
computer game world P1,P2,P3
art/ceramics P1,P2,P3
computer movie maker P1,P2
Home
Economics
beads, bags, design, sew P1
computer Minecraft at late care P1,P2,P3
crafts P1,P2,P3
babysitting P1,P2
wire/wood sculptures P3
cooking/kids kitchen P1,P2,P3
ABC for teens-reach dreams
creative writing P1,P2,P3
crime & puzzlement P1,P3
debate it P1
detective crime scene P1,P2
journey of you/journal P1,P2
magic P2
reading P2
fiction fandom P2
Hunger Games
Twilight
Harry Potter P2
mythology/monsters P2
super heroes P2
vocabulary (pop it) P1
P2,P3
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.
3.
5.
4.
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 8, 2015 at LSSC,
Leesburg Campus and 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.
Date
Signature
Visa
Mastercard
Name on card
Card Number
Billing Mailing Address
American Express
Discover
$ 25.00
3 Digit
Security Code
Expiration Date
Amount Non-Refundable
Leadership Training
City
State
Office Use Only
Receipt No.
Zip
Paid By
Receipt Date
Cashier Initials
Continuing Education
9501 U.S. Highway 441 Leesburg, FL 34788
(352) 365-3556