Name *

First Name

Last Name

Gender *

Male

Female

Phone *

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you under 18? *

Yes

No

Parent/Guardian Name

(Please fill out only if under 18)

First Name

Last Name

Parent/Guardian Phone

(###)

###

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Former Special Needs Experience

Please check all that apply.

Fluent in American Sign Language (ASL)

Special Education Teacher/Paraeducator

Heathcare Professional

Other

Have you volunteered at previous CCE Night to Shine or Summer Sizzle events? *

Yes

No

Group or Organization *

Please indicate if you are volunteering as part of a larger group or organization. If none, please select "Not Applicable".

Not Applicable

Calvary Chapel Eastside

Bellevue Sarang Church

YoungLife/Capernaum

Newport High School

Summit Classical Christian School (SCCS)

Other

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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