SERVICEWORKX

SERVICEWORX REGISTRATION FORM

Rising 6^th, 7^th & 8^th graders of the parish are invited to participate in a week-long service experience at Assumption the week of July 12-17.

Camper Registration Fee330.0

Number of ServiceWorx volunteers registering in your family REQUIRED Please fill out this field.
Camper 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade entering as of September 2020 6th 7th 8th
- Gender REQUIRED Boy Girl Please fill out this field.
Camper 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade entering as of September 2020 6th 7th 8th
- Gender REQUIRED Boy Girl Please fill out this field.
Camper 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade entering as of September 2020 6th 7th 8th
- Gender REQUIRED Boy Girl Please fill out this field.
Camper 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade entering as of September 2020 6th 7th 8th
- Gender REQUIRED Boy Girl Please fill out this field.

Parent Information

Parent First Name REQUIRED Please fill out this field. Please enter valid data.
Parent Last Name REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.

Sign Up/Payment Requirements

There are only a limited number of volunteer slots available, so the fee for your volunteer(s) must be paid by credit card to complete your registration. Slots will be filled in order of completed sign up and payment.

Once capacity is met all additional registrations will be on a wait list, in order of completed sign up and payment. All payments for volunteers remaining on the waitlist will be refunded in full.

If your volunteer is accepted into the program and has to back out, your payment will be returned in full if his/her slot can be filled. If your volunteer's slot cannot be filled, you will receive a partial refund of $230 for each volunteer registered. All monies collected go directly to Center for FaithJustice/ServiceWorx.

I have read and understand the registration/payment requirements as outlined above. REQUIRED Yes Please fill out this field.