Holland Teen Court Community Service Form

Teen Court

City of Holland Holland, Michigan
270 South River Avenue


COMMUNITY SERVICE
WORK LOG
      Community Service Location: __________________________

      Participant’s Name: __________________________________

      Community Service Due Date: __________________________

							 Signature
 Date             Project                     Hours          of Supervisor

 ___________      _______________________     ______         ________________
           
 ___________      _______________________     ______         ________________
         
 ___________      _______________________     ______         ________________
            
 ___________      _______________________     ______         ________________
                     
 ___________      _______________________     ______         ________________

 ___________      _______________________     ______         ________________

 ___________      _______________________     ______         ________________
 
 ___________      _______________________     ______         ________________
                                                
      Total Hours:     ______
      
Supervisor's Comments:
 
 
	
	Supervisor's Signature: ____________________   Date: _______________

	Participant's Signature ____________________   Date: _______________
 

It is the participant's responsibility to get this work log to Teen Court.
Fax: 616.355.1490, Mail: Teen Court, 270 S. River Ave., Holland, MI 49423