Volunteer Application Form

Personal Information:

Name: ______

Address:______

City: ______

Postal Code: ______Email Address: ______

Phone Number Day: ______Evening: ______

Date of Birth (optional): ______/______/______ Youth Volunteer (12-15 years)

DayMonth Year

Have you volunteered at LangPioneerVillage before? Yes  No

If yes, how long have you been a volunteer at Lang? ______year(s)

Emergency Contact Info:

Emergency Contact 1: ______Relationship to you:______

Phone Number Day: ______Evening:______

Emergency Contact 2: ______Relationship to you:______

Phone Number Day: ______Evening:______

How did you find out about volunteering at LangPioneerVillageMuseum?

 Friend Brochure Advertisement

 Lang Staff/Volunteer Member  Craft/Trade Guild

 While visiting LangPioneerVillage Other. Please specify______

Please indicate the Volunteer Position(s) that you are interested in:

Costuming Department VolunteerInterpretation Volunteer

Gift Shop VolunteerProp Production Volunteer

Historic Buildings & Facilities VolunteerSpecial Events Volunteer

Historical Gardener VolunteerHistorical Research Volunteer

Conservation/Collection Volunteer Other ______

Availability: Volunteer opportunities are subject to museum needs which vary from time to time. To assist us in determining how your schedule might fit with our needs, please check day &/or evenings below according to your usual availability:

Day / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
daytime
evening

Comments/Preferences:______

How many hours per week______or month______would you like to volunteer?

Experience and Skills

Please tell us about the talents and abilities that you would bring to volunteering at LangPioneerVillageMuseum?

______

Languages (other than English) spoken______written______

Goals

What do you personally hope to achieve by volunteering at LangPioneerVillageMuseum?

______

Personal information contained on this form is collected under the authority of Section 29(2) of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c.M.56 as amended and will be used for the sole purpose of volunteer management and event planning at Lang Pioneer Village. If you have any questions about the collection, use or disclosure of this information by the County of Peterborough, please contact the CAO or Clerk, County of Peterborough, 470 Water Street, Peterborough, Ontario K9H 3M3 (705-743-0380

Declaration:

I ______, hereby consent to the collection, use and dissemination of personal information for the purpose of volunteer management and event planning by staff of Lang Pioneer Village.

______/_____/______

Signed (under 16 requires signature of parent or guardian) Day Month Year

Please mail, fax or e-mail your completed application to the Administrative/Volunteer Coordinator at:

LangPioneerVillageMuseumTel: 705 295-6694

c/o County of PeterboroughFax: 705 295-6644

470 Water StreetE-mail:

Peterborough, ON K9H 3M3