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.
Are you 18 years or older?
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)
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)?
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: