Youth and Elder Application

If you have questions about this application please call 303-830-9035 or email kelly@bessieshope.org.

Group Name: *

Primary Mailing Address for Group

Street: *

City: *

State: *

Zip Code: *

Primary Phone Number for Group: *

How did you hear about Bessie's Hope?:

How often does your group intend to visit?:

When are the best times for your visits?:

Please give us an idea of when your group will be able to participate in our program.

I understand each youth must have a Bessie's Hope Waiver and Release form completed before thier first visit. : *

I Agree

To download our waiver and release, please click here: https://www.bessieshope.org/sites/default/files/BH%20Youth%20Waiver%20an....

Primary Group Leader

Contact information for the primary group leader.

First Name: *

Last Name: *

Email Address: *

Home email:

For teachers - we often have our volunteer appreciation event at the end of the summer. We struggle to get the word out to our wonderful teacher, group leaders since we have primarily school contact information. Please provide us with a summer email address so we can send the invitation there. If the email address above is a good way to contact you throughout the year, please skip this field.

Street Address: *

City: *

State:

Zip Code: *

Home Phone:

Cell Phone:

We appreciate having a cell phone number that we can use in the case of last minute cancellations or schedule changes.

Second Group Leader

Contact information for another adult assisting primary group leader.

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Email Address:

Third Group Leader

Contact information for another adult assisting primary group leader.

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Email Address:

Group Demographics

Please estimate the demographics of your group. This information is important for some of the grants that help Bessie's Hope exist.

Number of Adult Volunteers: *

Information about Youth Volunteers

Number of Youth Volunteers: *

Age Range of Youth: *

Number of Male: *

Number of Female: *

Number of Low Income: *

Number of African American: *

Number of Asian: *

Number of Caucasian: *

Number of Hispanic: *

Number if Native American: *

Number of "Other": *

Questions or Comments:

If you have any specific questions or comments please type them here.

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Youth and Elder Application

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