First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone

Cell Phone

Please enter YOUR NAME exactly as it appears on your student ID, and student records. {---(REQUIRED)*

Please enter YOUR - MCPS ID {---(REQUIRED)*

Please enter what GRADE you are currently in now. {---(REQUIRED)*

Please enter the name of the SCHOOL you currently attend {---(REQUIRED)*

Please enter the NAME of YOUR - First Period Teacher {---(REQUIRED)*

Please enter YOUR current EMAIL address. Use YOUR SCHOOL EMAIL address if you have one {---(REQUIRED)*

Please enter the First and Last Name of your Parent or Guardian where you live. {---(REQUIRED)*

Please enter the phone number WHERE YOU LIVE. not required

Please enter your Cell Phone number. {---(REQUIRED) YOU MUST ENTER ANY PHONE NUMBER*

Please enter your current AGE today? {---(REQUIRED) *

SELECT BELOW HOW YOU WANT TO HELP, SELECT ALL THAT APPLY

Please let us know when you are willing to help. Provide Dates and Times you can help

Have you volunteered for Home At Last Sanctuary and received Montgomery County SSL credit?

If you volunteered here before? When? Did you have fun? Can we make it better? Thank you for your service. Hal!

Are you a member of a Boy Scout or Girls Scout Troop?

If you are a member of a Boy Scout or Girl Scout troop please enter your troop number.

You understand that you are requesting to attend and volunteer and will await your invitation to attend. You understand you will not show up without receiving an email inviting to attend. You understand that if you say you will be there HALS is depending on you being there. You understand that If you say you will be there and do not show up someone else will also miss out on an opportunity to help. If you agree and have answered all the question above are truthful and complete. ENTER YOUR FIRST and LAST NAME and TODAY'S DATE BELOW. *