Clone of RFK Club Mentoring Log

RFK Club Mentoring Log - James Kee Tucker

Visit/Transportation Log
Your Name: James Kee Tucker*
Child Passenger Name(s): Nathaneal Ziemer*
Other Adult Passenger(s):
Date of Visit:*

MonthDayYear
Odometer readings are REQUIRED for each form submission. You may enter your odomter reading by uploading a picture of your odometer OR by manually entering in the reading. DO NOT submit form without this information.
Beginning Odometer Reading(upload pix of odometer):

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Beginning Odometer Reading(enter manually):
Pick Up Address: 1717 E. Almanac Drive, West Covina, CA, 91791*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Time of Pick Up:*

:HourMinutesAM/PM Option
Stop #1 Location:
Stop #1 Odometer Reading(upload pix of odometer):

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Stop #1 Odometer Reading(enter manually):
Stop #2 Location:
Stop #2 Odometer Reading(upload pix of odometer):

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Stop #2 Odometer Reading(enter manually):
Stop #3 Location:
Stop #3 Odometer Reading(upload pix of odometer):

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Stop #3 Odometer Reading(enter manually):
What we did today & additional notes from the visit:
Best Pix of the Day!

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Drop Off Address: 1717 E. Almanac Drive, West Covina, CA, 91791*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Drop Off Time:*

:HourMinutesAM/PM Option
Drop Off Odometer Reading(upload pix of odometer):

Upload a File

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Drop Off Odometer Reading(enter manually):
Total Contact Hours:*
Should be Empty:

RFK Club Mentoring Log - James Kee Tucker