Mandatory Service Hour Tracking Form

Immaculate Conception School Mandatory Service Hour Tracking Form

In order for service hours to qualify for the Mandatory Service Hour Program, the activity

must be performed by parents, legal guardians, siblings over 21 years of age,

or grandparents of children in grades K-8 for the 2009-2010 school year.

Your Name: ___________________________________________________

Your Phone Number: ____________________________________________

Your Email Address: _____________________________________________

Name of any family child attending grades K-8 in ICS during the 2007-2008 school year:________________________________________

Your Relationship to this Child: ______________________________________________________

(parent, legal guardian, sibling over 21 years of age, or grandparent)

Number of Hours You Worked Today: _____________

Service Activity: _______________________

Your Signature: _________________________________________________

Today's Date: _____________________________

Activity Coordinator’s Signature: _________________________________________________(FORM WILL NOT BE ACCEPTED WITHOUT SIGNATURE!!!)

This form must be submitted to your service activity coordinator at the end of your service

activity in order for you to receive credit for your service hours.

Thank you very much for your service to our school and parish!!!

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