Volunteer Registration Form

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Host name: Bon Secours Richmond Hope Therapy Center
Camp dates: August 12, 2019 - August 16, 2019
Camp location/address: University of Richmond Weinstein Center 23 Boatwright Dr. Richmond, VA 23226

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 Abby Benton at abigail_benton@bshsi.org

Volunteer Name *

First Name Last Name

Gender *

Male

Female

Other

Date of Birth *

YYYY

This question is intentionally left blank

option 1

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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)

What school/organization are you from?

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