Personal Information

Today's Date (mm/dd/yyyy)*

First Name*

Last Name*

Middle Initial

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip*

Home Phone*

Cell Phone

E-mail*

Birth Date (mm/dd/yyyy)*

Gender*

Female

Male

How did you hear about our volunteer program?*

From a member/I am a member - see below From a friend Newspaper - see below Website Naper Settlement employee - see below Visited the museum

Brochure From another volunteer - see below TV/Radio From a board member - see below Other - see below

Name of the person who referred you:

Are you currently a Naper Settlement Season Pass Holder or Member?*

Yes

No

What skills would you like to gain from your volunteer experience at Naper Settlement?*

Why would you like to volunteer at Naper Settlement?*

Education Completed

Please indicate current grade or last grade completed.*

Grade 4 Grade 5

Grade 6 Grade 7

School attending or last school attended*

Parent/Guardian Information

Name*

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip*

Daytime Phone*

Evening Phone

Cell Phone

Parent/Guardian Current Employment Information

Company Name

Address

City

State

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip

E-mail address at work

Occupation

Full or Part Time

Full Time

Part Time

If necessary, may we contact you at work?

Yes

No

Emergency Contact

Parents or guardians, please provide a secondary emergency contact, in case we cannot reach you.

Name*

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip*

Home Phone*

Work Phone

Cell Phone

Relationship*

Optional Information: This medical information is optional.

Medical Information

Allergies

Year of Last Tetanus Shot

Are you allergic to peanuts, bee or wasp stings?

Yes

No

Commitment of Volunteer Service

If Naper Settlement/Naperville Heritage Society agrees to accept your services as a volunteer, we will commit to providing you adequate information, training, and supervision as a volunteer to carry out the responsibilities of the position. You will agree to perform duties as outlined in the position description to the best of your abilities, meet time and duty commitments or provide adequate notice to your supervisor so alternate arrangements can be made, and adhere to the policies and procedures of the organization, including confidentiality of information, you understand that volunteers are not employees of the organization, receive no direct monetary compensation and no special consideration if applying for a paid position. Naper Settlement/Naperville Heritage Society will do our best to make you experience as a volunteer a productive and rewarding one.

Naper Settlement Volunteer Agreement

To complete the application process, read the following volunteer agreements and give your electronic signature where it is appropriate.

Photo Release and Hold Harmless Agreement:
I agree that Naper Settlement/Naperville Heritage Society may use my likeness in any brochures or promotional
materials that will be used to promote Naper Settlement/Naperville Heritage Society. As a volunteer or parent/guardian of a volunteer, I recognize and acknowledge that there may be a risk of physical injury and I agree to assume the full risk of any injuries, including death, damages or loss which I or my minor child may sustain as a result of participating in any and all activities connected with or associated with the volunteer program. I agree to release and hold harmless Naper Settlement/Naperville Heritage Society, its agents, employees, volunteers and the City of Naperville from all damages, judgments, expenses (including attorney fees), costs or liabilities suffered because of injury or damage of property, which may arise out of, or as a consequence of any volunteer work I may perform. I understand that my volunteer status may be terminated at any time for failure to comply with policies and procedures of Naper Settlement/Naperville Heritage Society, including those of the volunteer program, or when in the judgment of the society, continued service as a volunteer would be contrary to the best interest of the organization.

I understand that Naper Settlement/Naperville Heritage Society may conduct periodic background checks and I will provide any additional information as requested.

I agree to provide my social security number upon request from Naper Settlement/Naperville Heritage Society, as required by the City of Naperville for all volunteers authorized to make purchases for events and programs.

The confidentiality of all information provided in this volunteer application will be respected.

Sign and Date:

I agree that the statements made in this volunteer application have been freely given, are correct and true and that I accept the Photo Release and Hold Harmless Agreements and will provide information for a background check and social security number if requested. Naper Settlement/Naperville Heritage Society will hold all information provided in this application and agreement in strict confidence.

Parent/Guardian Signature*

Date (mm/dd/yyyy)*