Court Ordered Community Service
Volunteer Application Form & Guidelines
Restrictions
- No crimes against children or adult
- No crimes of domestic violence
- No crimes of theft
- No drug offenses
- No sexual offenses
- No crimes against animals
Allowed
- Traffic violations
- Disorderly conduct
- Noise violations
- Public intoxication
- Driving under the influence
- Property damage
- If not listed, explain below
Service Requirements
- Availability: 8:30am to 2:15pm.
- Ability to provide service in the following areas: cleaning, organizing, filing papers, shredding paper,
landscaping, minor repairs, or any other job that does not involve working with children directly, but will benefit
our organization.
Procedures
1. Submit COMPLETED application to the Boys & Girls Club of Manhattan
2. Wait for a call from the volunteer coordinator to set up start date if service is needed
Name: _________________________________
Age: _______
Address: ______________________________________
Today’s Date: _____________
City ___________________ State ________
Primary Phone #: __________________________ Alternative Phone #: ________________________
For what charge(s) have you been ordered to perform Court Ordered Community Service?
_____________________________________________________________________________________
How many total hours do you need? ______________
When is the first due date of your court-ordered community service? ___________________
How many hours need to be completed by the date listed above? _______________________
When are the total hours of court ordered community service due? ____________________
What days each week are you available? ______________________
Between what hours are you available on the days listed above? _______________________
If we can only provide you with a portion of the total hours needed, should we contact you? Y / N
Who is your probation officer or the person you will be giving these hours to?
Name: _________________________________Phone Number: __________________
To receive community service hours at the Boys & Girls Club of Manhattan, I understand it is my
responsibility to perform my hours I committed to in a responsible manner. If I fail to meet the service
requirements at the Boys & Girls Club of Manhattan, I understand I will be unable to return to the Club.
By signing this form, I further understand that any false or misleading statements will be sufficient cause for
rejection of my application for court-ordered community service.
Signature: _____________________________________ Date: ___________________