Volunteer Application

Date

Name*

First NameMiddle NameLast Name

Phone Number*

Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Birthdate *

MonthDayYear

Are you 18 are older?*

YesNo

Please check one*

MaleFemale

Are you 14 or older?

YesNo

If not, please list the parent or guardian you will be volunteering with:

Emergency Contact*

Please check all areas you are willing to volunteer for:*

Please list specific Programs/Activities/Seasons

Please list any applicable certifications

Please list any past applicable experience

Volunteer Informed Consent and Release

I offer to volunteer my services to the Geneseo Park District, and recognize that I will not be paid for my time. As a volunteer, I acknowledge that there are certain risks of physical injury to volunteers in their activities, and I agree to assume full risk of any and all injuries, damages or loss, that I may sustain as a result of said participation. I further agree to waive and relinquish all claims I may have (or accrue to me) as a result of volunteering in this activity against the Geneseo Park District, including its officers, officials, agents, volunteers and employees. Additionally, I hereby give consent for the Park District to use photos or video coverage of me in future publications and promotions, and that these photos/videos remain the property of the Park District.

Criminal Background Check

By providing my name below, I herby verify that I have not been convicted of or found to be a child sex offender. *

Date

By providing my name below, I herby authorize the Geneseo Park District to conduct an Illinois State Police Criminal Background Investigation.*

Date

We need the following information to complete a criminal background check

Race*