FRIENDS OF SLEEPING BEAR - VOLUNTEER SERVICE AGREEMENT

  • VOLUNTEER SERVICE AGREEMENT- NATURAL & CULTURAL RESOURCES

  • U.S. Citizen or Permanent Resident
  • Format: (000) 000-0000.
  • Age

  • ETHNICITY & RACE (Optional): Please report both ethnicity and race and tell us if you are a veteran or have a disability. Multiracial respondents may select two or more races. This information will inform our understanding of diversity and inclusion among the volunteer force in the natural and cultural resource areas. 14a. Ethnicity (Select one):14b. Race (Select one or more, regardless of ethnicity):14c. Are you a Veteran? American Indian or Alaskan NativeAsian Hispanic or Latino Black or African AmericanWhite Not Hispanic or Latino 14d. Do you have disability? Native Hawaiian or Other Pacific Islander

  • Ethnicity (Select One):
  • Race (Select one or more, regardless of ethnicity):
  • Are you a Veteran?
  • Do you have a disability?

  • EMERGENCY CONTACT INFORMATION

  • Format: (000) 000-0000.
    • Parental Consent for Volunteers Under Age 18 
    • Format: (000) 000-0000.

    • 31. I affirm that I am the parent/guardian of the above named volunteer. I understand that the agency volunteer program does not provide compensation, except as otherwise provided by law; and that the service will not confer on the volunteer the status of a Federal employee. I have read the attached description of the service that the volunteer will perform. I give my permission for to participate in the specified volunteer activity.

    • Date
       / /

  • I do hereby volunteer my services as described above, to assist in authorized activities at Sleeping Bear Dunes National Lakeshore to follow all applicable safety guidelines. See attached OF301b attached if a member of a group.

  • Date
     / /

  • PUBLIC BURDEN STATEMENT

    According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0080. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. USDA, DOI, DOC and DOD prohibit discrimination in all programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. Not all prohibited bases apply to all programs.

    PRIVACY ACT STATEMENT

    Collection and use is covered by Privacy Act System of Records OPM/GOVT-1 and USDA/OP-1, and is consistent with the provisions of 5 USC 552a (Privacy Act of 1974), which authorizes acceptance of the information requested on this form. The data will be used to maintain official records of volunteers of the USDA and USDI for the purposes of tort claims and injury compensation. Furnishing this data is voluntary, however if this form is incomplete, enrollment in the program cannot proceed.

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