Manna Project Spring Break 2010

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1. Last Name
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2. First Name
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3. E-mail
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4. Cell phone
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5. Emergency Contact Info (name and phone number)
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6. Health Insurance Company AND Policy Number
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7. Your Service Site
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8. YOUR COMMITMENT TO EFFECTIVE CITIZENSHIP & SERVICE
I will not possess or use alcohol or other controlled substances while participating in any events sponsored by the Office of Active Citizenship and Service/Vanderbilt University. I understand that the use of alcohol or controlled substances may result in my dismissal from this program with any costs for return to Nashville,TN to be at my own expense. I also understand that my actions may jeopardize participation in other OACS-related programs. I recognize the need for this commitment to effectively participate in this program.

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