Online Registration Form for Service Learning

All students participating in Service Learning must fill out this online Service Learning Registration Form when they BEGIN their service. After all hours are complete, please return to the Service Learning Website and complete the Online Completion form for Service Learning (Step 11 on the info for student webpage)

First Name*
Last Name*
Student ID Number*
Phone Number*
Email Address*
Enter Email Confirm Email
Course Information
Course Department and Number (ex. CHDV 115, SOC 100)*

List the course you are doing your service learning for. Students doing service that is not tied to a course, please type in Independent Study)
Your TEACHER'S NAME- Put your professor's First and Last Name ONLY*
Write YOUR TEACHER'S First and Last NAME below. (ex. Wing Cheung, Amanda Hill)
Professor's email address*
Enter Email Confirm Email
Minimum number of Hours required
Please enter a number from 0 to 100.
Approximate number of hours you expect to complete*
Community Organization Information
Name of Organization*
Supervisor's Name*
Program Name and or Volunteer Role*
examples may be: Preschool assistant, classroom volunteer, food distribution, etc.
Supervisor's Email*
Enter Email Confirm Email
Waiver of Liability*
- I agree
You are agreeing to participate in a service activity and waive district liability as set forth in this declaration for said participation. All persons traveling to and from the volunteer site shall be deemed to have waived all claims against the District or the State of California for injury, accident, illness or death occurring during the trip. I agree that any accidents or infractions (moving violations) incurred while driving my own vehicle are the sole responsibility of myself. I will not hold Palomar College, its employees and agents responsible for any such damage, injury or liabilities. Further, injuries and or illnesses occurring during or as the result of my participation in the service learning class should be covered in accordance with the premiums of the student insurance program as the secondary health insurance carrier.

Service Learning

Service Learning

Course Information

Community Organization Information

Contact Information

Service Learning