Register Below For More Information

Check Back Soon For Mitzvah Mission Updates and More!
 


 

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MITZVAH CORPS - VOLUNTEER APPPLICATION
Participant's First and Last Name Mother's Name  
Participant's
E-mail Address
Father's Name
Participant's
Cell Phone Number
Family E-mail Address
Home Phone Number

Mother's
Cell Phone Number

Grade and School Father's
Cell Phone Number
Mailing Address City, State Zip  
TELL US A BIT ABOUT YOURSELF!
Hobbies:    

Count Me In For:

Lawn Mowing/PLanting Flowers/Raking Leaves
Grocery Shopping
Painting
Snow Shoveling
Changing Light bulbs/Batteries
Moving/Packing Boxes/ Furniture Schlepping
 ?!?! I Love Surprises....I'll Do Almost Anything!
 Other
 

Talents:  
Interests:  
MITZVAH CORPS SWEATSHIRT**

 Youth SM Qty:   Youth MD Qty:   Youth LG Qty:  Youth XL Qty:  

  Adult SM Qty:
   Adult MD Qty:   Adult LG Qty:   Adult XL Qty:  
  
** $10 Suggested Donation Per Sweatshirt 

SUPPORT THE PROGRAM (OPTIONAL)
Yes!  I/We would like to support the program with a contribution of:
  $180 - Sponsors a Mitzvah Mission
  $360 - Sponsors 12 Senior Connections
  Other Amount:
 
Please confirm the total to be charged to your credit card for your contribution and sweatshirts:  
Name on Card: Card Number:
Card Type: Exp. Date:     
PARENTAL PERMISSION
I give my son/daughter  permission to participate in the Mitzvah Corps programs.
 Signature:   Date:



 

Problems with this form?  Please call Misia at (414) 228-8000 ext. 211 or e-mail [email protected].