Form_Volunteer_Registration

Two References (Cannot not be Relatives) & Background Check

Name Ref 1

First

Last

Email Ref 1

Phone Ref 1

Address Ref 1

Address Line 1

Address Line 2

City

State

Zip Code

Name Ref 2

First

Last

Email Ref 2

Phone Ref 2

Address Ref 2

Address Line 1

Address Line 2

City

State

Zip Code

Are you willing to submit to a Pennsylvania Background Check per Pennsylvania Child Abuse History Clearance.

Yes
No
Need more Information

I hereby authorize person(s), prior employer(s) and organizations(s) as stated in this application provide this facility with any relevant information. I hereby agree to release all such person(s) from any liability regard the use of this information. I understand and will abide by the rules and regulations, including, but not limited to uniform, training requirements and privacy regulations of The Mill at Anselma Preservation and Educational Trust, Inc. I understand should my personal, contact or demographic information should change while I am a The Mill at Anselma volunteer, I am obliged to immediately inform the Volunteer Services Department.

Signature

Clear Signature

Date

Volunteer Experience and Availability

Areas of Interest. Check all that apply

Two References (Cannot not be Relatives) & Background Check