BAXTER STATE PARK

2010 VOLUNTEER SERVICE APPLICATION - ________NEW _______RENEWAL

Individual or Leader Name:___________________________________________ Date of Birth:____________

Address:_________________________________________________________________

Telephone Number:( ___) __________Work/Cell Number (___)__________

Email: _________________________________

In Case of Emergency, Notify:

Name:________________________________________________________________

Address: ______________________________________________________________

Telephone: ______ - ______ - ________

If Family/Group - List Other Members:

Name                                            Date of Birth            Name                                       Phone Number

1. ______________________     ___________             _____________________    ______________

2. ______________________      ___________           _____________________    ______________

3. ______________________      ___________           _____________________    ______________

4. _______________________    ___________           _____________________    ______________

5. _______________________    ___________           _____________________    ______________

 

Please indicate type of volunteer service, location, and dates you are available:

Location:_____________________________________Dates:______________________

TRAILS__________CAMPGROUNDS________SFMA_________I/E_________OTHER___________

 

Check or list specific skill(s) that could be useful to BSP:

Rough Carpentry____ Roofing____ Chainsaw Operation_____ Forestry_____

Boundary Work_____ Trail Maintenance______ Other Skills:_____________________

 

AGREEMENT FOR VOLUNTEER SERVICE

I UNDERSTAND THAT IF ACCEPTED AS A VOLUNTEER:

  1. I shall be subject to all Baxter State Park Rules & Regulations.
  2. I shall not have the status of an employee of the State of Maine.
  3. I shall not receive compensation for my services.
  4. I will provide all necessary camping equipment and supplies: unless advised of other arrangements by Park staff.
  5. I will be available for a minimum of 50% of the length of my stay for volunteer projects.
  6. I will operate Baxter Park Vehicles and/or equipment only if I hold proper license, have specific permission from and am under supervision of Baxter Park staff.
  7. I shall maintain an appearance and conduct myself in a manner complimentary to Baxter State Park.
  8. I shall not use my status as a volunteer to secure access to areas of the park not accessible to others, for the purpose of obtaining material by camera, video camera, or other means to be used for commercial purposes.

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 you wish to be enrolled in BSP's accident plan? Yes ______ No ______

If "no", please list name & policy number of your company:  _____________________________

I have read the "Agreement for Volunteer Service" and by my signature below, acknowledge my understanding of its conditions and my agreement to abide by them.

Insurance: Do any other family/group members, 18 years of age or older, wish to be enrolled in the Baxter State Park Accident program?

Signature(s) of Applicant(s)

Other Family/Group Members      Date                      Ins. (Y/N)         If No, Company Name & Policy #

1. ______________________     ___________             __________   _______________________________

2. ______________________      ___________           __________   _______________________________

3. ______________________      ___________           __________   _______________________________

4. _______________________    ___________           __________   _______________________________

5. _______________________    ___________           __________   _______________________________

Volunteer Coordinator:___________________________________Date:____________________

Accepted/Rejected:_____________________________________ Date:____________________

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