Athens Regional Library System

Date:

*Name: Mr. Mrs. Dr. Miss Ms.

*Date of Birth: / /

*Address:

Apartment/Suite:

*City:

*State:

*Zip Code:

*Phone Number: - -

Email address:

How would you prefer to be contacted about volunteering?
Phone Email

Education (select last year completed):
Grade 5 6 7 8
High School 1 2 3 4
College 1 2 3 4
Graduate 1 2 3 4

*Is this volunteer activity/service in conjunction with a school organization or program?
Yes No

If yes, what program or organization?

*Have you been convicted of a felony in the past 10 years which has not been annulled, expunged or sealed by court? Yes No

If yes, please explain:

*Please indicate any area in which you would be interested in volunteering:

If you chose "Other," please describe your interest:

Are you proficient in any languages other than English? Yes No

Which one(s)?

Please list any computer skills you possess:

In case of an emergency, who should we contact?

Relationship to you:

Phone: - -

Please read the following and check the "I agree" box. If you are asked to volunteer, you will be expected to sign and date a copy of this form when you arrive for training.

In connection with my voluntary involvement in activities undertaken for, and with the participation and support of the Athens-Clarke County Libraries, I (or child's parent or legal guardian) hereby agree, for myself, my heirs, assigns, executors, and administrators to release, discharge, and hold harmless Athens-Clarke County Libraries and its employees, agents, and volunteers from all claims, demands, actions or any cause or suit arising from injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release. In addition, I agree to keep confidential any patron information or library records I may encounter. I understand that the Athens-Clarke County Libraries do not provide medical coverage for volunteers. If qualified for volunteer service, I agree to abide by the rules and regulations of the Athens-Clarke County Libraries.

* I agree.