Manna Project Spring Break 2010
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1
. Last Name
Last Name
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2
. First Name
First Name
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3
. E-mail
E-mail
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4
. Cell phone
Cell phone
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5
. Emergency Contact Info (name and phone number)
Emergency Contact Info (name and phone number)
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6
. Health Insurance Company AND Policy Number
Health Insurance Company AND Policy Number
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7
. Your Service Site
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.
SIGNATURE:
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. SIGNATURE:
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