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Get Community Hours Form

Or ACTIVITY: HOURS COMPLETED (for this activity/organization): (please print) ADDRESS OF ORGANIZATION or ACTIVITY: START DATE (please print) SUPERVISOR OF ORGANIZATION or ACTIVITY: (please print name) (signature) (please print name) (signature) PHONE NUMBER PARENT/GUARDIAN’S CONSENT (under age 18): NOTES (please include description of duties or activity and any additional relevant information, e.g., schedule, etc.): PRINCIPAL’S SIGNATURE *pdc H: \SCHOOL\Community Hours.doc END .

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