Maintenance Volunteer Registration Form

Maintenance Volunteer Registration Form

Please let us know your availability and areas of interest
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Format: (000) 000-0000.
YesNo
Will you be receiving school credit or fulfilling graduation requirements?*
Emergency contact and phone number*

Preferences in Area of Volunteering*

Rows	Would love to!	Would like to.	Wouldn't mind helping.	Not this area.
General repairs like changing lights, replacing outlets, doorknobs and doors
Electric repairs
Plumbing repairs
Set up/take down chairs in the auditorium
Set up/take down special museum displays
Wash tablecloths
Clean windows
General clean up inside the museum
Clearing exterior drains and stairwells of leaves and debris
Collecting and removing debris, sticks and limbs from the grounds
Weeding and tending to the flower beds
Fixing the brick sidewalk

Weekly Availability *

Please list 3 references*

Emergency Medical Information (Please list any allergies, medications needed in the event of a reaction and any major medical conditions)*
YesNo
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.
Should be Empty: