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*Address:
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*City:
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*State:
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*Zip:
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*E-mail:
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| *Phone: |
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Occupation:
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| | *Please list any previous work experience (places, dates
of service, position held), or paste a resume:
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*How did you learn about volunteer opportunities
with ECHO Lake Aquarium and Science Center at the Leahy Center for Lake
Champlain?
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*Which volunteer positions interest you (please
order according to preference)?
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*Please describe any previous volunteer
experience:
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*We often have unexpected needs for volunteer
service throughout ECHO. To help us answer these needs, please list any
skills, hobbies, special training, or interests that you may have as
completely as possible (ex. foreign language, calligraphy, typing, drawing,
theater, etc.):
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*Please list any medical restrictions,
requirements, allergies, etc.:
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In case of emergency, notify: |
| *Name: |
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| *Address: |
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| *Work
Address: |
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| *Relationship: |
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| *Home
Telephone: |
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| *Work
Telephone: |
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| *Please indicate when
you are available:
Year Round
Summer Season
(June-August)
Fall (Sept - Dec.)
Spring (Jan - May)
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| Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
Sunday |
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| *Are
you available at least once a week? |
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| *If
Volunteer positions are full, would you like us to
keep your application on file for the next 6 months? |
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| *Have
you ever been convicted, imprisoned, been on
probation, parole or under supervision as a result of a
conviction, or been fined for any violation of the law? |
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| If yes, please give dates, details, and penalties for each
occurrence below. An answer of "yes" to this question does not constitute an
automatic bar on volunteering.
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| *May
we reproduce photos in which you appear in
ECHO promotional or educational materials? |
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| *By
checking this box, I
certify that the answers given in this application are true and complete to
the best of my knowledge. I authorize investigation of all statements
contained herein and the references listed above to give you any and all
pertinent information they may have, personal or otherwise, and release all
parties from liability for any damage that may result from furnishing same
to you. |
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*Please enter
the code
which appears
to the right: |
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