Volunteer Registration Form

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Host name: North Florida School of Special Education
Camp dates: June 21, 2021 - June 25, 2021
Camp location/address: North Florida School of Special Education 223 Mill Creek Rd. Jacksonville, FL 32211

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 Rina Park at icanbikejaxfl@gmail.com

Volunteer First Name *

Volunteer Last Name *

Gender

Male

Female

Other

Clear selection

Date of Birth *

YYYY

T-shirt size

XXL

Clear selection

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) *

Home Address (City) *

Home Address (Zip Code) *

5 digits only, please. e.g., 22011

Home Address State/Province *

Emergency Contact Name *

Emergency Contact Phone *

Enter 10 digits only, please. e.g., 3031112222

Parent/Guardian Email (if volunteer is under 18 y/o)

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