2011 Summer of Service Application Application deadline is May 13th, 2011 at 5 p.m.
Name __________________________________________________________________________________________________________ Gender ____________
Birth Date ______/______/___________
Entering _______ grade next fall
Current Age ____________
School (next fall) ________________________________________________
Home Address ________________________________
Youth Phone # ________________________________
Youth E-mail ____________________________________________________
Parent/Guardian Name(s) _________________________________________________
Primary Phone # ________________________
Parent/Guardian E-mail (this is how we will confirm your child’s projects) ___________________________________________________ Please list two contacts in case of emergency: (please circle the best number to reach each one) Name
T-shirt size (adult sizes):
[ ] Sm
[ ] Med
Does the Youth Volunteer have any allergies? [ ] No
[ ] Yes (explain)
Is the Youth Volunteer currently taking any medication? [ ] No
[ ] XXL ___________
[ ] Yes (explain)
How did you hear about YVC’s Summer of Service? _____________________________________________________________________
I, ______________________________ (parent or legal guardian) give permission for my child, ______________________________ to participate in volunteer activities of the Youth Volunteer Corps of Lawrence, KS. I understand that The United Way Roger Hill Volunteer Center of the United Way of Douglas County may use my child’s photo for promotional purposes for the purpose of recruiting volunteers. On behalf of myself, my child, our respective heirs, executors, next of kin, administrators, estates, and assigns, I release the United Way of Douglas County, Inc., and all of its employees, representatives, agents, staff, sponsors, volunteers, and members of its Board of Directors from any and all claims, costs, expenses, damages, and liabilities, including personal injury, death, or property damage, arising out of or in any manner related to volunteer activities associated with the Youth Volunteer Corps. Parent/Legal Guardian Name (Please Print) __________________________________________________________________________ Parent/Legal Guardian Signature ______________________________________________________________
----------------------------------------------------------------OFFICE USE ONLY--------------------------------------------------------------Arrival Date/Time: ________________________________
Received by: ____________________________
□Added to Ydat (if new)
PLEASE NOTE: We are unable to accept faxed applications. You may e-mail a scanned copy of your application to firstname.lastname@example.org or you can drop off or mail your application directly to our office at 2518 Ridge Court, Suite 200, Lawrence, KS 66046. United Way office hours are 8am-5pm. Please call if you’d like to drop off outside of those hours. All applications will be time-stamped as we receive them. Each project has a limited number of spaces available, and spots will be filled on a first come, first serve basis. The sooner your application is received, the better your chances of being placed at your first choice(s) for the desired week(s). Choose your desired projects below by placing a 1 or 2, (1 being your first choice) next to the agency name under the desired week(s). For example, if GaDuGi SafeCenter is the only project you want to do during Week 2, leave the other project blank. If you are willing to do Prairie Park Nature Center if GaDuGi fills up before we receive your application, place a number 2 next to it. If you place ANY number next to an agency, you are agreeing to be enlisted on that project, even if it is your second choice. We will do our best to give you your first choices and all projects will be confirmed before the summer begins. There is no minimum or maximum number of weeks to sign up for, but by choosing an agency, you are committing to serving the entire week, Monday-Thursday, 9am-2pm (unless you have chosen a summer long project). Failure to show up without notice for any day of the project may result in your spot being released to someone on our waiting list.
Week 1: June 6th – 9th RANK Week 2: June 13th – 16th Hidden Valley Camp Prairie Park Nature Center nd ---------- No 2 Project -------GaDuGi SafeCenter (14 & up)
RANK Week 3: June 20th – 23rd School Gardens Week Senior Focus Week
Week 4: June 27th – 30th DCCDA Hunger Focus Week
RANK Week 6: July 18th – 21st Midnight Farm (CLO) Boys and Girls Club
RANK Week 5: July 11th – 14th Eco Week Operation WildLife (14 & up)
Project Site Okanis Garden (Prairie Moon Waldorf School) Community Connections Center Garden (USD 497)
Project Times Fridays from 8-10am (10 weeks total) Fridays from 9-11am (10 weeks total)
Youth Name (Please Print) _____________________________________________________________________ Youth Signature ____________________________________________________________ Date _____________
2011 Summer Project Descriptions Projects in Weeks 1-6 are Mon-Thur, 9am-2pm. Projects are subject to change as needed. Week 1 (June 6th – 9th) Lawrence Hidden Valley Camp: Get campsites and trails ready for The Lawrence Hidden Valley’s Girl Scout camp! Hidden Valley is a wilderness camp in the middle of Lawrence that has shelters, trails, cabins and plenty of flora and fauna.
Week 2 (June 13th -16th) Prairie Park Nature Center: Help us beautify the enclosures for the owls, hawks, falcons and eagles! We will also help with other projects as needed around the Center. Prairie Park Nature Center is an 80-acre nature reserve in Lawrence that features a lake, trails, and wildlife and houses various ecosystems, including wetlands, prairie and woodlands. GaDuGi SafeCenter: GaDuGi needs your help to create media outreach for awareness about sexual violence in our community! GaDuGi SafeCenter provides comprehensive services for those affected by sexual violence in Douglas and Jefferson Counties. Ages 14 and up only for this project please.
Week 3 (June 20th – 23rd) School Gardens Week: Help at four local elementary schools to grow food, nourish flowers and other foliage and keep weeds at bay in their gardens. Spend one day each at Deerfield, Pinckney, Sunflower and Kennedy Elementary Schools. Senior Focus Week: Young and old work together on various activities, such as creating living histories, helping out with yard work, and more. Spend one day each at Brandon Woods, Jayhawk Area Agency on Aging, Project LIVELY and Meals on Wheels.
Week 4 (June 27th – 30th) Douglas County Child Development Association (DCCDA): Support the local food movement! Assist with a garden at a local childcare center all week. DCCDA is working to make locally grown foods more available to young children and their families. Hunger Focus Week: Try out your cooking and serving skills! We will be helping prepare and serve food to those who need it throughout Douglas County. Spend one day each at Salvation Army, Ballard Community Services, Just Food, and LINK.
Week 5 (July 11th – July 14th ) Eco Week: Have you been to all of Douglas County’s ecosystems? Visit them, learn about them and help clean them up! We will spend one day each at the Wakarusa Wetlands, the Baker Wetlands, the Kansas River and Clinton Lake. Operation WildLife (OWL) : Work with injured animals, from birds and bobcats to minks and muskrats! We will be helping with animal rehabilitation and other projects as needed. Operation WildLife provides rehabilitation and veterinary services to injured and orphaned wild animals. Must be 14 or older for this project.
Week 6 (July 18th – July 21st) Midnight Farm (Community Living Opportunities): We will help create a sensory trail for Midnight Farm’s therapeutic horseback riding program. CLO operates Midnight Farm, where children and adults with developmental disabilities can explore and enjoy nature. Boys and Girls Club: Do you like hanging out with kids? At Boys and Girls Club we will help with various activities for younger children throughout the week. Boys and Girls Club provides after-school and summer programming for youth throughout Lawrence.
Summer-long Projects Okanis Garden: Help cultivate, maintain, and harvest the vegetable garden throughout the summer. We will help out at the Okanis st th Garden (located at Prairie Moon School) on Friday mornings from 8-10am. 20 hours total, to be completed June 1 – August 14 . Community Connections Center Garden (USD 497) : Help maintain and harvest the vegetable garden and butterfly garden, and garden with and mentor students with disabilities. We will be at the CCC Garden on Friday mornings from 9-11am. 20 hours total, to be st th completed June 1 – August 14 .
We want to see you there!