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KCHB Service Hours Request Form

  1. KCHB SERVICE HOURS REQUEST FORM INSTRUCTIONS

    THE SERVICE HOURS REQUEST FORM IS NOT YOUR PROOF OF SERVICE. KCHB will review the service hours request and will send you a certificate of hours served. Photo proof of participation with correct meta data is required. KCHB has the right to use any submitted materials in future KCHB promotions.

  2. ONLY required if volunteer is a minor

  3. Parent/guardian email if volunteer is a minor

  4. Parent/guardian phone number if volunteer is a minor

  5. CERTIFICATE IN-PERSON PICKUP OR MAIL TO ADDRESS*

  6. ONLY required if you wish you have your certificate mailed

  7. Include the location for cleanups

  8. ONLY required for cleanups

  9. Attach photo (only 1 required per service)

  10. Attach photo (only 1 required per service)

  11. Attach photo (only 1 required per service)

  12. Include the location for cleanups

  13. ONLY required for cleanups

  14. Attach photo (only 1 required per service)

  15. Attach photo (only 1 required per service)

  16. Attach photo (only 1 required per service)

  17. Include the location for cleanups

  18. ONLY required for cleanups

  19. Attach photo (only 1 required per service)

  20. Attach photo (only 1 required per service)

  21. Attach photo (only 1 required per service)

  22. TRUTH AND ACCURACY OF FORM*

  23. Leave This Blank: