Heartwood Volunteer Substitute Teacher Application

Your Name*

First NameLast Name

Birth Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

How did you hear about us?*

My child is in your programFamily/FriendOther

Name(s) of child(ren) in our program.

Select program(s) you would like to volunteer substitute in:*

Huckleberries , 11 a.m.- 3 p.m. (ages 3.5-4)Salmonberries, 11 a.m.-3 p.m. (ages 5-11)

If you have a child in our program, what is your preference:

Substitute in my child's class onlySubstitute in a class other than the one my child is in.Substitute in any class.Other

How many times per year would you be willing to sub?*

1-56-1011+Other

Which days may you be available?*

Would you like to volunteer for planned days off? These are usually arranged 2+ weeks in advance.*

YesNoOther

Would you like to volunteer for teacher sick days? These are typically arranged at 8am on the morning of a class.*

YesNoOther

Does your employer offer Volunteer Grants?*

YesNoN/AOther

Comments:

Liability Waiver: I understand that Heartwood Nature Programs take place entirely outdoors, and that there are risks which naturally occur whenever children and adults are outside. BY SIGNING this Liability Waiver I agree to hold landowners, Heartwood Nature Programs/The Heartwood Foundation and all of its members harmless for any injury resulting from my visit and volunteer work. I further agree to work safely around all others and place their safety and my own above all other considerations. I will notify a Heartwood Nature Programs/Heartwood Foundation representative immediately if I should receive any injury. If fatigued I will stop work until I recover. I will remain hydrated and watch for potential hazards to myself and other volunteers. I will report unsafe conditions or behavior at once.

SIGNATURE*