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Volunteer Application Form
Full Name:
Home Phone:
Business Phone:
Your Date of Birth:
Full Address:
How did you hear about our volunteer programs?
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Have you volunteered with us before?
If yes, in what year(s) and what did you do?
Why do you want to volunteer?
What skills, talents or hobbies will you be able to share?
Have you volunteered elsewhere?true
If yes, where and what did you do?
Place of employment or school:
Please note your current availability:
EMERGENCY CONTACT INFORMATION:
Name / Phone / Relationship:
Name / Phone / Relationship:
List any medical conditions we should know of:
CONSENT & CERTIFICATION FOR BACKGROUND CHECK FOR INDIVIDUALS 18 YEARS OR OLDER
Important Note: The following information and consent is necessary in order to conduct a proper review of your application for volunteering. This is to ensure the safety of all children visiting the museum and at community outreach events that MPDM participates in. This information will be kept confidential. Thank you. I consent to the release of information to the Mount Pleasant Discovery Museum to conduct, a background screening check with law enforcement, the Child Abuse Central Registry, previous employers and any other persons. I understand that this permission is part of my application for a position with Mount Pleasant Discovery Museum. I further understand that the information released is for official use by the Mount Pleasant Discovery Museum. I certify that the information provided in this application is true and correct, and been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, and I release Mount Pleasant Discovery Museum from any liability whatsoever for supplying such information. I understand that I will NOT be paid or otherwise compensated for my services as a volunteer. I agree to abide by any and all museum policies and understand if I do not abide by the museum policies, rules and regulations, I may be dismissed from my position as a volunteer.
Your Date of Birth:
Gender:
Ethnicity:

*Ethnicity and Gender are asked only for the purpose of identifying the correct person on the background check.
Signature :
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