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: *

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

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Time of Pick Up: *

: Hour Minutes AM/PM Option
Stop #1 Location:
Stop #1 Odometer Reading(upload pix of odometer):
Stop #1 Odometer Reading(enter manually):
Stop #2 Location:
Stop #2 Odometer Reading(upload pix of odometer):
Stop #2 Odometer Reading(enter manually):
Stop #3 Location:
Stop #3 Odometer Reading(upload pix of odometer):
Stop #3 Odometer Reading(enter manually):
What we did today & additional notes from the visit:
Best Pix of the Day!
Drop Off Address: 1717 E. Almanac Drive, West Covina, CA, 91791 *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Drop Off Time: *

: Hour Minutes AM/PM Option
Drop Off Odometer Reading(upload pix of odometer):
Drop Off Odometer Reading(enter manually):
Total Contact Hours: *
Should be Empty:

RFK Club Mentoring Log - James Kee Tucker