Volunteer Registration Form
Please let us know your availability and areas of interest
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
Are you 18 years or older?
*
Yes
No
Will you be receiving school credit or fulfilling graduation requirements?
*
Emergency contact and phone number
*
Preferences in Area of Volunteering
*
Would love to!
Would like to.
Wouldn't mind helping.
Not this area.
Grounds Maintenance
Front Desk
Museum Store
Technical Support
Genealogy/Historical Research
Docent
Maintenance
Graphic Design/Marketing
Archival Process
Special Events
Administrative Support
Outreach Lectures
Translations
Weekly Availability
*
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Friday AM
Friday PM
Saturday AM
Saturday PM
Best for me
Not Available
Education Level
*
High School
College
Graduate School
Other
Are you retired?
*
Yes
No
Do you have any retail experience?
*
Yes
No
Please list your interests and hobbies
*
Skills or areas of expertise
*
Please list 3 references
*
Name
Phone Number
Email
Relation
Reference 1
Reference 2
Reference 3
Emergency Medical Information (Please list any allergies, medications needed in the event of a reaction and any major medical conditions)
*
Have you ever been charged with, convicted of, or pled guilty to a crime, either a misdemeanor or a felony (including but not limited to drug-related charges, child abuse, other crimes of violence, theft, or motor vehicle violations)?
*
Yes
No
If yes, please explain.
I, _________________, allow the Berks History Center to run a background check that includes child abuse clearance.
*
*PERMISSION from parent or guardian REQUIRED for youth under 18 years of age: ________________ has my permission to volunteer at the Berks History Center.
SUBMIT
Should be Empty: