KISKI AREA KEY CLUB
Verification of Service Hours
Name of Club Member:________________________________
Director of Activity:___________________________________
Number of Service Hours:______
Date:
Brief Explanation of Service: ___________________________
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Additional Comments: _________________________________
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Director's Signature:__________________________________
Director's Phone: ____________________________________
Signature of Club Member: ____________________________
THIS FORM MUST BE COMPLETED IN ORDER FOR YOU TO RECEIVE FULL
CREDIT FOR YOUR SERVICE HOURS OUTSIDE OF OUR CLUB ACTIVITIES.
