Peoria Park District

Volunteer Questionnaire

General Information

Name ______

Address______

Phone (Specify home or cell)______

Email ______

Type of contact that is best for you: Phone____ Email_____ Mail_____

Emergency Contact

Name ______Phone ______

Employer (if any) ______Occupation ______

Driver’s License number* ______Date of Birth** ______

Have you ever been convicted of a crime? (Felony or misdemeanor involving violence, theft, or dishonesty) *** YES_____ NO_____ If yes, please describe ____________

______

*All regular volunteer assignments are contingent upon the successful completion of screening requirements such as background check, driver check, and drug screen.

**Some volunteer assignments have an age requirements. Volunteers 13 years and younger require adult supervision when volunteering)

***Convictions will not necessarily be a bar to volunteering, Every instance and explanation will be considered individually

Are you seeking volunteer hours to fulfill court ordered community service? ______

Please provide two personal references who are not relatives:

Name Address Phone

______

______

Personal Information and Experience

Luthy Botanical Garden offers many different volunteering opportunities for all skill and ability ranges. Please provide us with some information about what interests you and what areas of responsibility you would be willing to assist with. We have many routine tasks that are part of general garden operations as well as special events which take place on evenings and weekends. Tasks range in physical involvement so please specify if a task is beyond your physical capabilities due to disability or injury.

Do you garden at home? If yes, how long have you enjoyed this hobby? ______

______

______

Are there specific areas of the Garden you are interested in (Such as greenhouse crops, floral show setup, new plantings or construction, education, fundraising, special events, gift shop and office aid, or general garden maintenance i.e. weeding, planting, etc.)______

______

Do you have experience working with children and/or elderly?______

Are you interested in assisting the educator with classes or tours?______

Would you like to be involved with fundraising ideas or new projects ideas for the future of the garden?

______

What environmental or horticulture related topics interest you? Such as food production, composting, climate change, native gardens, beneficial insects, herbs, invasive and endangered species, water and air pollution concerns, alternative energy, etc.

______

______

Do you possess any special skills or expertise that would be of benefit to the garden?______

______

Do you volunteer elsewhere? ______

Are you fulfilling Master Gardener or Naturalist hours?______

If not, are you interested in either of these programs? ______

Availability

DAY: Time:(morning or afternoon)

Monday am______pm______

Tuesday am______pm______

Wednesday am______pm______

Thursday am______pm______

Friday am______pm______

Saturday am______pm______

Are you available in the evenings for events if needed? ______