BAXTER STATE PARK
FAMILY/GROUP VOLUNTEER SERVICE APPLICATION
DATES AVAILABLE:_____________________ Group/Org Name:_______________________
Contact Person:_____________________________ Address:_____________________________
Phone #:___________________________ Email:______________________________________
| FAMILY/GROUP MEMBERS: | EMERGENCY CONTACT: | ||
|
NAME
|
DOB |
NAME
|
PHONE # |
| 1.__________________________ | ______ | _________________________ | ____________ |
| 2.__________________________ | ______ | _________________________ | ____________ |
| 3.__________________________ | ______ | _________________________ | ____________ |
| 4.__________________________ | ______ | _________________________ | ____________ |
| 5.__________________________ | ______ | _________________________ | ____________ |
EDUCATION: Indicate highest level completed
|
Elementary
|
High School |
College
|
Major |
| 1._______________ | __________________ | __________________ | __________________ |
| 2._______________ | __________________ | __________________ | __________________ |
| 3._______________ | __________________ | __________________ | __________________ |
| 4._______________ | __________________ | __________________ | __________________ |
| 5._______________ | __________________ | __________________ | __________________ |
| OCCUPATION | INTERESTS | HOBBIES | SPECIAL SKILLS |
| 1._________________ | __________________ | __________________ | __________________ |
| 2._________________ | __________________ | __________________ | __________________ |
| 3._________________ | __________________ | __________________ | __________________ |
| 4._________________ | __________________ | __________________ | __________________ |
| 5._________________ | __________________ | __________________ | __________________ |
AGREEMENT FOR VOLUNTEER SERVICE
I UNDERSTAND THAT IF ACCEPTED AS A VOLUNTEER:
Insurance: All volunteers must be 18 years of age or older to be covered under Baxter State Park volunteer program accident policy. If you have your own health insurance, you can stretch Baxter Park's limited budget by not enrolling in their accident policy program.
Do these family/group members, 18 years or older, wish to be enrolled in BSP's accident plan?
| Signature of Applicant(s) | Date | Insurance(Yes or No) |
If no, company name & policy # |
| 1._______________________ | ______________ | ___________ | _______________________ |
| 2._______________________ | ______________ | ___________ | _______________________ |
| 3._______________________ | ______________ | ___________ | _______________________ |
| 4._______________________ | ______________ | ___________ | _______________________ |
| 5._______________________ | ______________ | ___________ | _______________________ |
APPLICATION ACCEPTED: _____________________(Chief Ranger)DATE:____________
APPLICATION REJECTED: _________________________________DATE: ___________