Volunteer Registration Form

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Host name: Miracle League of Connecticut, Inc.
Camp dates: July 26, 2021 - July 30, 2021
Camp location/address: Conard High School 110 Beechwood Rd. West Hartford, CT 06107

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 Mike Michaud at miracleleaguect@comcast.net

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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