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Spanish Version
Project Request Form
Volunteer Form
Volunteers are needed for this national day of service.
Sign-up your organization or yourself to volunteer by
contacting Nancy Aguilar, Community Service Department
(909) 797-2489 ext 260, via email naguilar@yucaipa.org.
Following the completion of projects volunteers can
gather at Community Park for a complimentary lunch.
Saturday, October 25, 2014 at 8:00 a.m.
Same day sign-ups are accepted!
Yucaipa Community Park
34900 Oak Glen Rd Yucaipa, CA 92399
Necesitamos voluntarios para este Día Nacional Del Servicio.
Para más información por favor llame a Nancy Aguilar,
Departamento de Servicio Comunitario
(909) 797-2489 ext 260, víacorreo electrónico
naguilar@yucaipa.org. Después de finalización de proyectos los
voluntarios pueden júntarse en el Yucaipa Community Park
para un almuerzo.
¡Usted se puede registrar el mismo día!
Sabado, Octubre 25, 2014 a las 8:00 a.m.
Yucaipa Community Park
34900 Oak Glen Rd Yucaipa, CA 92399
MAKE A DIFFERENCE DAY
PROJECT REQUEST FORM
GROUP/ORGANIZATION CONTACT INFORMATION
NAME
NAME OF CONTACT PERSON
STREET ADDRESS
CITY, ST, ZIP
EMAIL ADDRESS
WORK PHONE
CELL PHONE
DESCRIPTION/LOCATION OF PROJECT
PROJECT DETAILS
HOW MANY VOLUNTEERS ARE NEEDED TO COMPLETE THE PROJECT?
WHAT TIME WOULD YOU LIKE THE PROJECT TO START AND FINISH?
WHAT EQUIPMENT, MATERIALS, AND SUPPLIES ARE NEEDED TO COMPLETE THE PROJECT?
WHAT SUPPLIES DO VOLUNTEERS NEED TO BRING TO COMPLETE THE PROJECT?
WILL YOU PROVIDE THE EQUIPMENT NEEDED?
YES
NO
HOW MANY PEOPLE WILL BE IMPACTED BY THE COMPLETION OF THIS PROJECT?
PLEASE RETURN FORM TO CITY HALL
Office: (909) 797-2489 ext. 260 FAX: (909) 790-9203
MAIL: 34272 Yucaipa Blvd. Yucaipa, Ca 92399
DEADLINE: WEDNESDAY, OCTOBER 8, 2014
FOR OFFICE USE ONLY
Date Application Received:
Recived By:
MAKE A DIFFERENCE DAY
VOLUNTEER FORM
CONTACT INFORMATION
FIRST, LAST NAME
GROUP/ORGANIZATION
STREET ADDRESS
CITY, ST, ZIP
EMAIL ADDRESS
HOME PHONE
NUMBER OF PEOPLE IN GROUP
CELL PHONE
MARK JOB PREFERENCE
__ REPAIRS - using tools, painting and lifting
__ CLEANING - trash pick up
__ HOSPITALITY - greeting volunteers, set up meals
__ LANDSCAPING - planting trees
__ OTHER __________________________________________
VOLUNTEER HOURS
How many hours do you anticipate working? _______ HOURS
How many hours does your organization anticipate working? _______ HOURS
_______ HOURS X _______ VOLUNTEER(S)= _______ TOAL HOURS
EMERGENCY INFORMATION
FIRST NAME
LAST NAME
STREET ADDRESS
CITY, ST, ZIP
CELL PHONE
PLEASE RETURN FORM TO CITY HALL
OFFICE USE ONLY
Date Received:
Office: (909) 797-2489 ext 260 FAX: (909) 790-9203
MAIL: 34272 Yucaipa Blvd. Yucaipa, CA 92399
DEADLINE: WEDNESDAY, OCTOBER 8, 2014
Facility Credits Earned:
Received By: