Volunteer Center Of
Bergen County
64 Passaic St.
Hackensack, NJ 07601
Tel: 201-489-9454
Fax: 201-489-1995
Learn About Us     |    Contact Us     |    Support Us     |    Site Map     |      Email:  info@bergenvolunteers.org


 

All Day of Caring participants must pre-register for the event. Please complete and submit this form; we will confirm your registration as soon as we receive it. 
 
* required
*FAMILY NAME
*TOTAL NUMBER OF VOLUNTEERS
*STREET ADDRESS
*CITY*
*STATE
*ZIP
*DAYTIME PHONE
*EVENING PHONE
*E-MAIL
HOW DID YOU HEAR ABOUT FAMILY DAY OF CARING?

 

*NAME(S) OF ALL PARTICIPANTS
 18 AND OVER
T-SHIRT SIZE
Adult 1
L XL
Adult 2
L XL
Adult 3
L XL
Adult 4
L XL

NAMES AND AGES OF ALL PARTICIPANTS UNDER AGE 18*
CHILD 1
      Age 
CHILD 2
      Age 
CHILD 3
      Age 
CHILD 4
      Age 

Child Adult
CHILD 1 M L ADULT 1 L XL
 CHILD 2 M L ADULT 2 L XL
 CHILD 3 M L ADULT 3 L XL
CHILD 4 M L ADULT 4 L XL

ANY SPECIAL SKILLS OR OTHER COMMENTS:


 
We will be participating in the following project:
Villa Marie Claire May 2003
Brightside Manor  June 2003

By submitting this form and in participating in the Family Day of Caring, I myself, my executors and administrators and assigns, do hereby release and discharge the Family Day of Caring, their employees and volunteers, all sponsoring or cooperating businesses, organizations and municipalities, their employees and agents, from all claims, damages, demands, actions, causes of action or any other claim of whatsoever nature arising out of my/our participation in the event or while in transit to or from the designated project site. I also give full permission for use of my name and photograph in connection with this event.
 

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