Community Service Registration form

2. Please complete the following information to register for the Day of Service activities.

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6. Registration Information

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10. Name*

12. Phone Number*

14. Email Address

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20. Activities are scheduled throughout the day starting at 10:00 am and ending at 4:00 pm.

22. TOILETRY/HYGIENE KITS for Area Homeless
    -- Select One --Register me

    11:00 a.m. – 2:00 p.m. Assemble toiletry/hygiene kits for the area homeless. Children, youth, and adults are encouraged to help assist in assembling the kits. The children will be taught the importance of assisting those in need and in a videotaped segment will explain what they have learned as a result of participating in the project.

24. registrant name(s)

26. Golden Living Center (Sleepy Hollow) Fellowship
    -- Select One --Register me.

    10:00 a.m.-12:00 p.m. Fellowship activity with seniors at Golden Living Center (Sleepy Hollow) consisting of conversation, companionship, music and activities. Activities may consist of puppetry ministry performance, dancing, and arts and crafts.

28. registrant name(s)

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32. Beasley Square Maintenance/Repair
    -- Select One --Register me.

    11:00 a.m.-2:00 p.m. Fellowship, maintenance, and repair of Beasley Square and delivery of baskets for the residents.

34. registrant name(s)

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38. Ladrey House Fellowship
    -- Select One --Register for this class.

    12:00 p.m.-2:00 p.m. Fellowship activity with seniors at Ladrey House consisting of conversation, companionship, music and activities. Activities may consist of puppetry ministry performance, dancing, and arts and crafts.

40. registrant name(s)

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44. Envoy of Alexandria Fellowship
    -- Select One --Register me.

    2:00 p.m.-3:00 p.m. Fellowship activity with seniors at Envoy of Alexandria consisting of conversation, companionship, music and activities. Activities may consist of puppetry ministry performance, dancing, and arts and crafts.

46. registrant name(s)

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50. Woodbine Rehabilitation and Healthcare Fellowship
    -- Select One --Register me.

    2:00 p.m.-4:00 p.m. Fellowship activity with seniors at Woodbine consisting of conversation, companionship, music and activities. Activities may consist of puppetry ministry performance, dancing, and arts and crafts.

52. If you have any questions, please contact Michael Cokley at michaelcokley@shiloh-bc.org.

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54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

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