Community Service Application


Name *
Prefix
First *
Last *
Suffix
Email *
Daytime Phone *
Cell/Pager *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Reason for community service? *
What are you willing to do in service to the community? (Check all that apply) *
 Pass out flyers for ACOPP events 
 Participate in ACOPP fundraiser events 
 General Clean-up after ACOPP events 
 Set-up for ACOPP events 
 Processing/collecting donations 

Emergency Contact:

Please provide at least two persons to contact in the event of an emergency:
Emergency Contact Name *
Prefix
First *
Last *
Suffix
Relationship *
Phone Number *
Emergency Contact Name *
Prefix
First *
Last *
Suffix
Relationship *
Phone Number *
Emergency Contact Name *
Prefix
First *
Last *
Suffix
Relationship *
Phone Number *

I, the applicant and undersigned, acknowledge and authorize ACOPP (Assisting Children of Prison Parents) to accept my offer to be a Volunteer, without compensation, at ACOPP. I understand that proper codes of conduct are necessary while on the premises a

Please print first, middle initial, and last name stating that you agree to the above terms. *
Today Date *

MM
/
DD
/
YYYY
Parent or Legal Guardian's first, middle initial and last name if you are under 18 years of age.
Today's Date

MM
/
DD
/
YYYY