Volunteer Registration Form
Host name:  Horse Heaven Hills Kiwanis
Camp dates:   July 29, 2019 - August 2, 2019
Camp location/address:  Southridge Sports Complex 2901 Southridge Blvd, Kennewick WA. 99337

We are pleased to offer this bike program to people with disabilities and look forward to having you play an important part in helping our riders learn to ride a two-wheel bicycle independently.

***NO PRIOR EXPERIENCE WORKING WITH PEOPLE WITH DISABILITIES IS NECESSARY***

AGE REQUIREMENT:  Volunteers must be at least 15 years old.  
If you are under 15, please contact the Camp Host for possible opportunities.

For questions please contact kristen hunt at skithelake@msn.com

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Volunteer Name *
First Name   Last Name
Gender *
Date of Birth *
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E-mail address *
Please ensure you have entered a valid email.  The Camp Host will use this address when corresponding with you.
Cell Phone *
Please enter 10 digits
Home Address (Number and Street) *
e.g., 123 Parker Pl.
Home Address (City) *
e.g., Fairfax
Home Address (Zip Code) *
5 digits only, please.  e.g., 22011
 Home Address State/Province *
Emergency Contact Name *
Emergency Contact Phone *
Please enter 10 digits
Parent/Guardian Email (if volunteer is under 18 y/o)
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