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Shasta County Youth/Peer Court
Community Service Verification Form
Name: _________________________________________________
Peer Court Case #: ______________ Home Phone: _____________
Community Service Site: _____________________________________
Contact Name and phone#: ___________________________________
Number of Hours to be completed: _____________________________
Document All Hours
| DATE | activity | HOUR | SIGNATURE |
COMMENTS:
Please provide original to Youth/Peer Court Coordinator and keep a copy for your record