WESTFIELD CIVIC SERVICE PROJECT

STUDENT/PARENT AGREEMENT FORM

 

 

Student Name:††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††† Phone:†††††††††††††††††††††††††††††††††††††††††††††††††††

Agency:††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Address:†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Contact Person:††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††† Phone:†††††††††††††††††††††††††††††††††††††††††††††††††††

Duties to be performed:

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PARENT AGREEMENT:† I give permission for †††††††††††††††††††††††††††††††††††††††††††††††††††††††††

to participate in the Civic Service Project.† I understand that my son/daughter must arrange his/her own transportation.

As a student, I agree to complete the hours I have committed to.† I will be:† SENSITIVE, RELIABLE, DISCRETE, FLEXIBLE, MATURE, and I will take INITIATIVE.† I will be responsible for the job that I do, and will keep a positive attitude.

We, the undersigned understand the responsibilities and commitment of this Civic Service Project.

 

__________________________________________________†††††††††† ††††††††††††††† ____________________________

Parent Signature††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† †††††††††††††††††††††††††††† Date 

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Student Signature††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Date††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† †††††††††††††††

 

NOTE:† Fill out this form and return to the classroom teacher by the assigned date.

 


 

 

 

Westfield High SchoolAttendance and Evaluation SheetCivic Service Project

††††††††† Attendance and Evaluation Sheet

 **Note:† You will need a separate sheet for each agency you volunteer for.

 

Student Name: †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† †††††††††††††††

Agency Name: _________________________________________

Agency Address:†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Contact Person(s):†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††† Phone: ______________________
††††††††††††††††††††††††††††† ___________________________________††††††††††††††† Email: ______________________

Date

Hours
(Ex. 12:00-4:30)

Duties Performed


Supervisorís Signature

 

 

 



 

 

 



 

 

 



 

 

 



 

 

 



 

 

 



 

 

 



 
Additional Comments/Feedback:

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Reminders

†††† **As this is a volunteer experience, you are NOT allowed to count hours of
†††††††† service for which you are paid.


†††† _____________________________
††††††††††††††††† Student Signature

††††† **By signing above you agree to perform this service according to the rules and guidelines
††††††††† detailed on the project description handout, and specifically to record only those hours
††††††††† you actually worked (no double hours) and service for which you did NOT receive pay.

 

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