2016 Adult Volunteer Form
This form is for potential volunteers, aged 18+. If you are under the age of 18, please fill out our Youth Volunteer Form.
Personal Information
Name (First & Last)
Your answer
Address
Your answer
City/State/Zip
Your answer
Home Phone (xxx-xxx-xxxx)
Your answer
Cell Phone (xxx-xxx-xxxx)
Your answer
Email Address
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
T-Shirt Size
Name preferred on ID Badge
Your answer
Languages Spoken
Your answer
Volunteer Experience & Interests
Do you have previous volunteer experience?
Required
If yes; where, when and in what capacity?
Your answer
What type of commitment would you like to make as a volunteer?
Volunteer Interests: Please check all that apply to your interest level.
Please list any special skills and hobbies that may be useful to the Kansas Children's Discovery Center
Your answer
Please write why you are interested in volunteering at the Discovery Center
Your answer
Education and Work Experience
If you hold any degrees, please list here:
Your answer
If you are currently employed, please list the name of your employer and position
Your answer
If you are retired, please briefly describe your previous career(s):
Your answer
For students, please list your current school/university, major (if applicable), and expected graduation date
Your answer
Background Information
Have you ever been convicted of a felony or misdemeanor other than a traffic violation?
If YES, please explain:
Your answer
Placement in a volunteer assignment is contingent upon successful completion of references and a criminal background check. Please provide contact information (Name, Relationship, Phone Number) for one reference that is not related to you:
Your answer
Photo Release
I give KCDC permission to photograph me for publication or other uses.
Required
Emergency Contact Information
Name
Your answer
Relationship
Your answer
Phone Number
Your answer
Authorization and Release
To begin my enrollment process as a volunteer with the Kansas Children's Discovery Center, I authorize an investigation of all statements contained in this application as may be necessary in arriving at an acceptance decision. I certify that the information above is true and complete to the best of my knowledge. I understand that my volunteer status may be terminated at any time for failure to comply with policies and procedures of the Discovery Center. I agree to abide by the rules and regulations set forth by the Discovery Center staff and Trustees.
Name
Your answer
Date
MM
/
DD
/
YYYY
By checking this box, I agree that my typed signature serves as my official signature to the above statement.
Required
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