Youths for Sarpy Habitat Participation Form

To be eligible for membership, this form must be completed and turned into the Habitat for Humanity of Sarpy County. If Sarpy Habitat accepts this form as true and complete, a certificate of award will be mailed to the youth.

Contact Information for youth participating

Name
Address
City
State		Zip
Contact Information for Adult Sponsor: (adult sponsor is an adult who accompanies the youth to witness that the youth does complete each club requirement. An adult sponsor can be a parent, guardian, troop leader, etc.)

Name
Address
City
State		Zip
Phone or email

Learn - please describe the activity the youth did to learn about Habitat:


Act - please describe the activity the youth did to help Sarpy Habitat:


Reflect - please describe the activity the youth did to reflect on Sarpy Habitat, and either attach project to this form, or turn it in to Sarpy Habitat office:


Young person verification: Please sign here to verify that you completed the above activities: Signature ____________________________ Adult Sponsor Verification: please sign here to verify the young person completed the above activities: Signature ____________________________

Turn this form into the Habitat for Humanity of Sarpy County office 1) Drop it off weekdays between the hours 9 a.m. and 3 p.m. at the Sarpy Habitat office, 119 W. Mission Ave., Suite H . 2) Mail it to Habitat for Humanity of Sarpy County P.O. Box 1664 Bellevue, NE 68005