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Name:
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Street Address
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City
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State
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Zip Code
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Home Phone
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Work Phone
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Cell Phone
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Email Address:
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Date of Birth
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Sex
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Male
Female
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Occupation
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Are you retired?
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Yes
No
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Education (level, degree, or area of study)
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Work activities you must avoid or do not enjoy
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List any medical restrictions, requirements, allergies
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How did you learn about Hagley's volunteer program?
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Are you a Hagley member?
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Yes
No
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If you are a youth volunteer (under age 18), please provide the name and phone number of a reference. This can be a teacher, counselor, coach, or employer.
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Please provide the name, address, and telephone number of a person to contact in case of an emergency.
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Please provide the name and telephone number for your Primary Care Physician.
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During which hours are you available for volunteer assignments? (check all that apply)
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Monday mornings
Monday afternoons
Tuesday mornings
Tuesday afternoons
Wednesday mornings
Wednesday afternoons
Thursday mornings
Thursday afternoons
Friday mornings
Friday afternoons
Saturday mornings
Saturday afternoons
Sunday mornings
Sunday afternoons
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During which months are you available for volunteer assignments?
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January
February
March
April
May
June
July
August
September
October
November
December
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Which area(s) are you interested in volunteering?
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Junior Creek Kids (6-9th grade)
Creek Kids Youth Interpreters (9-12th grade in the fall)
E. I. du Pont Garden (14+ years old)
Handwork Group (14+ years old)
Imprints Department (14+ years old)
Membership Office (14+ years old)
Pictorial Collections Department (14+ years old)
Holiday Wreath and Greens Workshop (14+ years old)
Invention Convention (14+ years old)
Fireworks Mailing (14+ years old)
Summer Camp Teen Counselors (15-18 years old)
Golden Pheasants Harvest Party (15+ years old)
Craft Show (15+ years old)
Cutting Garden (16+ years old)
Easy Does It! Discovery Assistants (16+ years old)
Flower Arrangers (16+ years old)
Interpretation in the Machine Shop and on Workers’ Hill (16+ years old)
Workers’ Garden (16+ years old)
Fireworks Shows (16+ years old)
Bike and Hike (16+ years old)
Car Show (16+ years old)
Victorine’s Valentine Day (16+ years old)
Belin House Restaurant (18+ years old)
Cutting Garden (16-18 years old or 18+ years old)
E. I. du Pont Garden (14-18 years old or 18+ years old)
Easy Does It! Discovery Assistants (16-18 years old or 18+ years old)
Flower Arrangers (16-18 years old or 18+ years old)
Handwork Group (14-18 years old or 18+ years old)
Imprints Department (14-18 years old or 18+ years old)
Interpreter/Docent in the Machine Shop (16-18 years old or 18+ years old)
Interpreter/Docent on Workers Hill(16-18 years old or 18+ years old)
Library Conservation Lab (18+ years old)
Manuscripts and Archives Department (18+ years old)
Manuscripts and Archives Department Clerical Assistant (18+ years old)
Membership Office (14-18 years old or 18+ years old)
Museum Collections Department (18+ years old)
Pictorial Collections Department (14-18 years old or 18+ years old)
Workers’ Garden (14-18 years old or 18+ years old)
Fireworks Shows (16-18 years old or 18+ years old)
Clerical (answering phones, filing, mailings, transcribing cassettes, typing, computer skills, etc.)
Bike and Hike (16-18 years old or 18+ years old)
Car Show (16-18 years old or 18+ years old)
Golden Pheasants Harvest Party (15-18 years old or 18+ years old)
Craft Show (15-18 years old or 18+ years old)
Holiday Wreath and Greens Workshop (14-18 years old or 18+ years old)
Belin House Restaurant Greeter (18+ years old)
Invention Convention (14-18 years old or 18+ years old)
Victorine’s Valentine Day (16-18 years old or 18+ years old)
Fireworks Mailing (14-18 years old or 18+ years old)
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Summarize special skills or qualifications you have acquired from employment, previous volunteer work, or other activities, including hobbies or sports that you would like to share with Hagley.
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Please list your previous volunteer experience, including location and types of duties.
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If you like, you may use this space to add comments or questions. (Optional)
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