Heartwood Volunteer Substitute Teacher Application

Your Name *

First Name Last Name

Birth Date *

Month Day Year

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

E-mail *

How did you hear about us? *

My child is in your program Family/Friend

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 only Substitute in a class other than the one my child is in. Substitute in any class.

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

1-5 6-10 11+

Which days may you be available? *

Monday Tuesday Wednesday Thursday Friday

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

Yes No

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

Yes No

Does your employer offer Volunteer Grants? *

Yes No N/A

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 *