249 Windward Passage, Clearwater, FL 33767

Clearwater Marine Aquarium

249 Windward Passage, Clearwater, FL 33767

727.441.1790 x258

VOLUNTEER APPLICATION

Please complete all parts of this application legibly (please print clearly). Incomplete forms will not be considered.

Name (Last/First)______

Street Address______

City/State/Zip______

Date of Birth______

Home # ______Cell#______Work# ______

Best time to reach you:______Home/Work/Cell (circle one)

E-mail: ______

VOLUNTEER RELEASE:

By signing this application, you (and your parent/guardian if you are under age 18 yrs.) are indicating that Clearwater Marine Aquarium, Inc.,assumes no responsibility for any injury suffered by you as a result of your volunteer work either on or off Clearwater Marine Aquarium premises, and if you are accepted into the Clearwater Marine Aquarium Volunteer program, neither you, nor your parent/guardian, nor heirs, administrators, executors, and assigns shall ever institute any action at law or otherwise against Clearwater Marine Aquarium as a result of any injury to you or your property resulting from your volunteer services, and you and your parent/guardian, for yourselves and your heirs,administrators, executors, and assigns HEREBY RELEASE CLEARWATER MARINE AQUARIUM, its Board of Directors, Officers, employees, and agents from and against any and all claims for personal injury to you or loss or damage to your property arising out of your activities undertaken as a volunteer. I understand that CMA will run a background legal check on me since I will or may be in contact with minors.

Executed this ____ day of ______, 20___.

______

Your signatureParent or Guardian (if volunteer under age 18)

EMERGENCY CONTACT INFORMATION

Name: ______Relationship: ______

Phone numbers: ______

TWO REFERENCES:

Contact Names: 1. ______2. ______

Phone# :______

What days are you available to volunteer? Mon. Tues. Wed. Thurs. Fri. Sat. Sun.
What is your shirt size? (circle one) Small Medium Large XL XXL
Why do you want to volunteer?
Have you ever volunteered at CMA before? If so when did you volunteer and in which dept?
Describe any prior volunteer experience.
What is your education level and area?
Describe any physical limitations we should be aware of.
List any appropriate certifications. (ex. SCUBA)

Employment

Employer’s name?
How long have you been employed with this company?
May we contact your employer?
Supervisor name & phone:
Work schedule:

Vehicle

Year:
Make:
Model:
Color:
License Tag #: State:

CRIMINAL HISTORY

An applicant found to have been convicted of, or having charges pending for a felony or misdemeanorinvolving a sex offense, child abuse or neglect, or related acts that would pose risks to children or the CMA Program’s credibility will not be accepted as a CMA volunteer.

Applicants with other misdemeanor or felony charges or convictions that would not pose a risk to childrenor negatively impact the credibility of the CMA Program will be considered on a case by case basisconsidering the time passed since the incident and the level of rehabilitation.

Have you ever been arrested for a crime? Yes ____ No _____

If yes, what was the charge? ______

Date of arrest/Disposition: ______County: ______