Community Service Form (Page 1)
NEBRASKA CITY HIGH SCHOOL
RECORD OF COMMUNITY INVOLVEMENT
Class of: (circle one) 2008, 2009, 2010, 2011 Date: ___________________
Student Name: __________________________ Telephone # __________________
Agency or org: __________________________ Telephone # __________________
Contact Person: _______________________________________________________
Proposed Project: _____________________________________________________
____________________________________________________________________
Dates of Project: ______________________________________________________
Student Signature (upon completion): ______________________________________
Parent Signature (upon completion): _______________________________________
Contact Person Signature (upon completion): ________________________________
Hours Completed: _______________________ School Verification: ____________
ON THE BACK> List times and dates served.
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Form must be submitted within 30 days of project completion.
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NO financial compensation should be given for Community Service.
- It should be understood that students
providing community service to area employers would not be considered
an employee; therefore they would not be covered by workers
compensation if injured. Parents should understand that if a
student is injured this should be submitted to their Health Insurance
Company.
- It is our opinion that most employers in this
area would protect any volunteer help from certain negligent acts under
the Employers General Liability policy as a additional insured.
We recommend that any question you may have concerning this issue be
addressed to the employer.
Nebraska City Public Schools
and
Educational Service Unit #4, Auburn, Nebraska
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