Allegan High School Community Service Form printable pdf download

Allegan High School Community Service Form

ALLEGAN HIGH SCHOOL

COMMUNITY SERVICE FORM

This record of community service is due by May 1

of your Senior year.

Read the guidelines on the reverse side before beginning your community service.

Student Name (Please Print):______________________________________________ Class of ______

Non‐profit group receiving your service:__________________________________________________

Description of the service:______________________________________________________________

____________________________________________________________________________________

Date(s) of Service: ____________________________________________________________________

Number of hours completed:______________

Student Signature:____________________________________________________________________

Parent Signature:___________________________________________ Date:_____________________

This individual or group agrees to defend, indemnify and save the District, the Board of Education, the individual members of the

Board of Education, and individual administrators, harmless against any and all claims, demands, costs, suits, claims for attorneys’

fees or other forms of liability as well as all court and/or administrative agency costs that may arise out of or by reason of

community service performed for this individual or group, by the aforementioned Allegan High School student, pursuant to this

agreement.

Signature of Supervisor:_________________________________________________

Contact Phone Number: (______) _______‐_________ Date:__________________

High School Approval:_______________________________________________________________________

Counselor or Principal

Entered into Powerschool

Allegan High School Community Service Form