Student Volunteer Application

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Palm Beach County
Animal Care and Control
Student Collection Program
7100 Belvedere Road, WPB 33411
Tammy Roberts 233-1281
Updated: Feb. 17, 2012
STUDENT COLLECTION VOLUNTEER PROGRAM: Ages 12-19 years.
Court Appointed Community Service applicants restricted to ages 12-16 only, State Attorney’s office will
not accept hours from this program for adults.
PROGRAM CRITERIA: Collect food and supplies for the Foster Care Program (only food and supplies
listed below will be accepted).
□ School Credit □ *Court Appointed
Application Date:
_____________________
Name: ____________________________________________
Mailing Address: ____________________________________________City & Zip: __________________
Home Phone: _________________________
Birth Date: _____________________E-Mail Address: ________________________________________
Parent’s Name: ______________________________Phone(s):__________________________________
*Parents, please review the letter on the back of the application. It is important that the parent and student
understand the job requirements.
Upon completion of the application and the supplies are verified, the student will receive a copy of the completed
form with signatures and total hours of credit. A new application is required each time the student drops off
supplies.
* * * * * * * * * * * * * * * * * * * * * * *
PLEASE CHECK ONE OR MORE OF THE FOLLOWING ITEMS YOU HAVE COLLECTED:
(You may collect a mixture of the items below. Totals below the required numbers will receive partial credit.)
( 10 )
Bundles of newspaper (10 hrs)
( 1 )
Kong Classic Dog Toy:
X-Large (10 hrs) Large (6 hrs), Medium (4 hrs), Small (2 hrs)
( 1 )
Kong Stuff’N Flavor Easy Treat any Flavor – 8 oz (5 hrs) 16 oz (10 hrs)
( 24 )
3 oz. cans of Kitten Iams or Kitten Nutro Chicken flavor canned wet food (10 hrs)
( 10 )
2.5 oz Jars of Baby Food - Stage 2, chicken, turkey, or veal with gravy [
cannot accept baby food
(5 hrs)
w/onion, garlic or vegetable ingredients
added]
( 2 )
5 lb bags of Science Diet or Nutro (DRY food), for Kittens (15 hrs)
( 1 )
3lb bag of Kitten Royal Canin Baby Cat (10 hrs)
( 1 )
20 lb container Cat Litter: Tidy Cat Scoopable or Fresh Step
(5 hrs)
( 1 )
Gift Card to any pet supply store, feed store, etc. (10 hrs)
Print Student Name ____________________________________________________________
Date _________________
Parent or Guardian Signature ___________________________________________________
Total hours this date __________
ACC Authorized Signature ______________________________________________________

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