Appendix I

SERVICE LEARNING AGENCY CONTACT FORM

Agency Name: St. Johns High School Redwing Marching Band_
Contact Person: Pamela J Gove_
Contact Phone: ____(517) 515-2519_____________
Contact Email: ___govep@michigan.gov___________
Contact Address: __3890 W. French Rd, St. Johns, MI 48879_______________
Description of Agency and Type of Service Learning Student will be engaged in:
Brittany attended Band Camp as an assistant Camp Nurse. Brittany was on call 24/7 from 7-2615 through 8-1-15. There were many different scenarios that had to be attended to during our
stay and Brittany was on top of everything. There were many different types of needs from the
students during the week dealing with items like: med check in, med distribution, headaches,
twisted ankles, upset stomachs, fevers, heat rash and a broken bone.

Signature of Agency Representative (Agreeing to student volunteer):

Pamela J. Gove
Printed or typed name

Signature