List special skills/or interests relating to your volunteer preference:
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Indicate experience working with students:
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NOTIFY IN CASE OF EMERGENCY – (required information)
Name: _______________________________ Primary telephone: ______________________ Work/Cell number: _________________
Name: _______________________________ Primary telephone: ______________________ Work/Cell number: _________________
I have children attending the following schools within the Greensburg Community School Corporation:
Greensburg Elementary School
Greensburg Jr. High School
Greensburg High School
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Applicant Name (printed)
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Applicant Signature
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Date
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