Volunteer Application - Lake Champlain Maritime Museum

Contact Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Mobile Phone *

Email *

Email

Confirm Email

How Can You Help?

Special Interests and Skills

List your special skills, interests, or vocational pursuits to help us find the right match between our volunteer needs and your interests.

I am willing to help with: (check all that apply)

If "other" please explain

Special Tool or Equipment Skills

Availability

When can you help? We're especially interested in people who are willing to commit to a set schedule, daily or weekly.

Employment and Volunteer History

If you don't mind, please tell us a little about what you do for work and any volunteer work you may have done or are doing.

Medical Training

Do you have any medical training to assist in an emergency? If yes and you'd be willing to help if the need arises, please describe your training.

Personal Details

Date of Birth *//

Allergies *

Yes
No

Do you have any allergies?

What are you allergic to? *

Medication *

Yes
No

Are you taking any medication?

What is it, and what is it for? *

Medical conditions *

Yes
No

Do you have any medical conditions that we should be aware of?

Please describe *

Emergency Information

Contact 1 Name *

First

Last

Contact 2 Name

First

Last

Contact 1 Phone *

Contact 2 Phone

Contact 1 Relation *

Contact 2 Relation

Insurance Company *

Policy number *

Signature

Permissions

I am 18+ years of age
I have received, read, and understood the LCMM volunteer handbook and agree to the terms and conditions there in.
I hereby agree to allow my photograph or likeness to be used in museum publications.
I agree to the use of photographs I submit to the museum, to be used in museum publications.

Signature *

Parent or Guardian *

If applicant is under the age of 18, we need the signature of a parent or guardian

Printed Name of Parent or Guardian *

Contact Information

How Can You Help?

Personal Details

Emergency Information

Signature

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