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Birthday A value is required. format xx/xx/xx

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Home Phone A value is required.

Work Phone A value is required.

Spouse Name A value is required.

Emergency Contact A value is required.

Emergency Contact Phone A value is required.

Do you have an interest in working with elementary school children? Yes No Please select an item.

Do you have any special talents or skills? (i.e.: sing, sew, etc...)

After receiving training, when would you be available to volunteer? (i.e.: Weekdays, Weekends, etc...)

How did you hear about us? A value is required.

Please list three references that we may contact:

1. Name A value is required. Phone A value is required.

2. Name A value is required. Phone A value is required.

3. Name A value is required. Phone A value is required.

Have you ever been convicted of or plead guilty to any crime(s): Yes No Please select an item.

If you selected "Yes," please describe crime(s) in full: A value is required.

As a condition of volunteering, I give permission for the Northern Indiana Historical Society d/b/a the Center for History to conduct a background check on me, which may include a review of sex offender registries, child abuse and criminal history records. I understand that, if appointed, my position is conditional upon the Center for History receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the Northern Indiana Historical Society d/b/a the Center for History, the officers, employees and volunteers thereof, or any other person or organization that may provide such information. I also understand that regardless of previous appointments, the Center for History is not obligated to appoint me to a volunteer position.

Do you agree to the above statement? Yes No Please select an item.

Are you under the age of 22? Yes No Please select an item. If you are under the age 18 you will need a signed note from a parent or guardian in order to volunteer for the Center for History.

Are you over the age of 65? Yes No Please select an item.

Please select the area(s) that you are interested in (you can select more than one):

Admission Desk Exhibits Archives Special Events Cabin Days
Civil War Program Clerical Data Entry Mailings TGIF (Summer Event)
Annual Dinner Tour Guide/Docent Marketing

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