Brant Historical Society Volunteer Application Form

Name

Street Address

Telephone

Emergency Contact Name

Telephone

Are you under 18? If yes, please fill out the information below.

Date of Birth (MM/DD/YYYY)

Name of Parent/Guardian

Work Phone Number

Name of Doctor

Telephone

Do you have any special health concerns? (ie. allergies, etc.)

1. When are you available to volunteer?

Weekends	Weekdays	Evenings	Special Events
Summer	Winter	Fall	Spring

Comments

2. What areas of the Museum interest you? Check all that apply.

Cooking/baking	Gardening	Education Programs
Research	Computers	Facility Maintenance
Collections	Office Duties	Interpretive Tours
Sewing	Exhibits	Committees/Board
Craft Demonstrations		Special Events
Fundraising/Promotion

Other interests

3. What skills or experience do you have to offer the museum? Check all that apply.

Computer skills	Maintenance	Education Programs	Sewing
Library Skills	Research	Public Speaking	Clerical
2^nd Language	Writing	Education	Camps
Building/Tinkering		Marketing/Fundraising
Craft Skills. If so, what kind
Are you available to assist with special events?			Yes No

Other skills

4. Do you have access to a car?

Yes No Not Applicable

5. How did you hear about the volunteer program?

6. What do you hope to gain from you experience here? What are your personal goals for your involvement at the Museum?

Please list 2 references that we could contact. Please include their phone number and the nature of the relationship (i.e. employer, teacher etc.)

Name
Phone #
Relationship

Name
Phone #
Relationship

Note: Due to issues regarding the security of the collection, as well as contact with young children, references may be checked, you may be called for an interview or requested to complete a security check.

I hereby declare that the forgoing information is true and complete to my knowledge. I understand that a false statement may disqualify me from the Brant Historical Society's volunteer program, or result in my dismissal. Further, I permit the Brant Historical Society to contact the individuals that I have listed as references to ascertain my suitability as a volunteer.

I Agree

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