Program Aide Interest Form

I am interested in helping as a Program Aide for the following program(s):

If you have any questions, please email us or call 402.558.8189.

Program Information

Once you have entered the number of programs you wish to help with, you will be able to enter the information about the specific programs.

Number of programs are you interested in (up to 6): *

Program 1: *

	Program Name:	Location:	Date:
1	Program Name:	Location:	Date:

Program 2: *

	Program Name:	Location:	Date:
2	Program Name:	Location:	Date:

Program 3: *

	Program Name:	Location:	Date:
3	Program Name:	Location:	Date:

Program 4: *

	Program Name:	Location:	Date:
4	Program Name:	Location:	Date:

Program 5: *

	Program Name:	Location:	Date:
5	Program Name:	Location:	Date:

Program 6: *

	Program Name:	Location:	Date:
6	Program Name:	Location:	Date:

Girl First Name: *

Girl Last Name: *

Girl Grade (Fall 2024): *

PA and CIT Status: *

Girl Phone: *

Girl Email: *

Parent/Caregiver Email: *

Emergency Contact Name: *

Emergency Contact Phone: *

Any Allergies or Dietary Restrictions?

0/300 characters