Hendricks Avenue Elementary PTA

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Hendricks Avenue Elementary PTA Building a safe,
loving and strong nest for our Eagle! VOLUNTEER
FORM
Thank you for giving your time and talents. You
help make Hendricks the special school it is!
Name______________________________________
E-mail ________________________ Name____________
__________________________ E-mail
________________________ Phone___________________
___________________ Cell Phone__________________
___ Age 18-20 years 21-61 years
62 years and over Gender Male /
Female Childs name/grade/teacher
__________________________________________________
__ Childs name/grade/teacher_____________________
________________________________ Please check
those programs, projects and events you are
interested in. Thank you for getting involved
and helping our children succeed! (Descriptions
are on the back)
Do you have any illnesses, injuries, or physical
limitations we should be aware of? If yes please
describe. ________________________________________
____________________________________________. Are
you currently taking any medication we should be
aware of in the event of emergency? ______________
__________________________________________________
____________________. Do you currently have any
contagious or infectious diseases? Yes
No If yes you must provide a doctors
statement verifying that you can work with the
public. Emergency contact Name_________________
________________ Relationship to you
_____________________________ Cell
phone_________________Home phone________________
__Work phone___________________
(This form gets turned in for the school to keep
the other form goes to the district office for
screening and is kept there for confidentiality
reasons.) Questions? Please dont hesitate to
call Laura Martin, HAE PTA Volunteer Coordinator
aura aura_lmt_at_yahoo.com 591-7262
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