Allegan High School Community Service Form

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ALLEGAN HIGH SCHOOL
COMMUNITY SERVICE FORM
This record of community service is due by May 1
 of your Senior year. 
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Read the guidelines on the reverse side before beginning your community service.
Student Name (Please Print):______________________________________________ Class of ______
Non‐profit group receiving your service:__________________________________________________
Description of the service:______________________________________________________________
____________________________________________________________________________________
Date(s) of Service: ____________________________________________________________________
Number of hours completed:______________
Student Signature:____________________________________________________________________
Parent Signature:___________________________________________ Date:_____________________
This individual or group agrees to defend, indemnify and save the District, the Board of Education, the individual members of the 
Board of Education, and individual administrators, harmless against any and all claims, demands, costs, suits, claims for attorneys’ 
fees or other forms of liability as well as all court and/or administrative agency costs that may arise out of or by reason of 
community service performed for this individual or group, by the aforementioned Allegan High School student, pursuant to this 
agreement. 
Signature of Supervisor:_________________________________________________
Contact Phone Number: (______) _______‐_________ Date:__________________
High School Approval:_______________________________________________________________________
                                       
Counselor or Principal
      Entered into Powerschool

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