Student Volunteer Registration and Parent Consent – Tampa Bay Chapter Chartering Ceremony

Student Volunteer Registration and Parent Consent – Tampa Bay Chapter Chartering Ceremony

Complete your student details, choose a volunteer information session, and provide consent if you’re under 18.
Student Information
Student legal first name
Student legal last name
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age on October 13, 2026
Student email address
example@example.com
Student mobile phone
Please enter a valid phone number.Format: (000) 000-0000.
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
ZIP
School or college name
Grade level or college year
Preferred name
Referring school counselor, teacher, club, church, or organization
Number of community service hours needed
Volunteer Information Session
Which volunteer information session can you attend?
Preferred reminder method
Accessibility accommodation needed for the information session or event
Volunteer Interest and Availability
Volunteer interests
Can you report to Egypt Shrine by 2:00 PM on October 13, 2026?
Can you remain through volunteer dismissal after the ceremony?
T-shirt size
Relevant experience, skills, leadership roles, languages, or accommodations
Emergency and Health Information
Emergency Contact Full Name

First NameMiddle NameLast Name
Relationship to Student
Emergency Contact Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency, Allergy, Medication, Dietary, or Mobility Information
Physician Name

First NameMiddle NameLast Name
Physician Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Information and Consent
Parent/Guardian Full Legal Name

First NameMiddle NameLast Name
Relationship to Student
Parent/Guardian Email Address
example@example.com
Parent/Guardian Primary Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/guardian address is the same as the student address
PARTICIPATION PERMISSION
EMERGENCY CARE AUTHORIZATION
CONDUCT AND SUPERVISION
TRANSPORTATION
PHOTO AND VIDEO PERMISSION
Parent/Guardian Electronic Signature
Typed Parent/Guardian Full Legal Name

First NameMiddle NameLast Name
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
By signing electronically, I certify that the information provided is accurate and that I have legal authority to give permission for this student.
Adult Student Acknowledgment
Age 18 or older acknowledgment
Photo/video permission
Adult student electronic signature
Typed full legal name

First NameMiddle NameLast Name
Signature date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Final Acknowledgments
Acknowledgments
Comments or questions
Please review the acknowledgments before continuing.
Signature (if required by your organization)
Should be Empty:

Student Volunteer Registration and Parent Consent – Tampa Bay Chapter Chartering Ceremony

Student Information

Volunteer Information Session

Volunteer Interest and Availability

Emergency and Health Information

Parent/Guardian Information and Consent

Adult Student Acknowledgment

Final Acknowledgments