THE GAISCE RECORD CARD

PARTICIPANTS NAME: ___________________________

PAL’S NAME: ___________________________________

COMMUNITY INVOLVEMENT ACTIVITY: State nature of activity

_______________________ 1 HOUR/WEEK FOR 13 or 26 WEEKS

Week DATE TIME SIGNATURE OF SUPERVISOR

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
If originally intended for 13 weeks but more weeks are being done,
please continue to fill in
14
15
16
17
18
19
20
21
22
23
24
25
26
Print Contact Name
& phone number for verification 

1
PERSONAL SKILL ACTIVITY: State nature of activity

__________________________ 1 HOUR/WEEK FOR 13 or 26 WEEKS

Week DATE TIME SIGNATURE OF SUPERVISOR

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
If originally intended for 13 weeks but more weeks are being done,
please continue to fill in
14
15
16
17
18
19
20
21
22
23
24
25
26
Print Contact Name
& phone number for verification 

2
PHYSICAL RECREATION ACTIVITY: State nature of activity
___________________________ 1 HOUR/WEEK FOR 13 or 26 WEEKS

Week DATE TIME SIGNATURE OF SUPERVISOR

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
If originally intended for 13 weeks but more weeks are being done,
please continue to fill in
14
15
16
17
18
19
20
21
22
23
24
25
26
Print Contact Name
& phone number for verification 

ADVENTURE JOURNEY: 2 DAYS AND 1 NIGHT

DATE VENUE SIGNATURE OF

From To SUPERVISOR

Provide contact number if organised individually for verification

3
4