Volunteer Request Form PERSONAL INFORMATION Name (required) Address (required) Date of Birth (required) Drivers License Number (required) Email Address (required) Cell Phone (required) Home Phone (required) VOLUNTEER INFORMATION List any special skills, training, interests, or hobbies that you have that may be useful when volunteering. Volunteer Experience Please indicate the types of volunteer work which interest you. (Check all that apply). Greet and assist visitorsSummer camp helperEvent Volunteer How often would you like to volunteer? Once a weekTwice a weekThree times a weekOnce a monthOn an as needed basisEvents Only Days available for volunteer work SunMonTuesWedThursFriSat Date you would be available to begin work References Please list three professional references. Reference 1 (required) Full Name Relationship Company Phone Reference 2 Full Name Relationship Company Phone Reference 3 Full Name Relationship Company Phone A FEW MORE DETAILS How did you hear about the SCCB volunteer program? In case of emergency, please contact Name: Phone: Relationship to volunteer: I understand that my relationship with the Sioux County Conservation or Sioux County is that of a volunteer. I understand that there are certain risks associated with these volunteer activities such as insect bites, scratches, falls or other injuries and illnesses. I hereby waive, release and forever hold harmless Sioux County, its officers, employees or agents from any and all claims arising from my or my minor children(s) volunteer activities with eh Sioux County Conservation department. I hereby authorize Sioux County Conservation to performa criminal background check before I begin (or anytime during) my volunteer activities with the Sioux County Conservation. I understand that the results of this background check may be used in determining my eligibility to participate as a volunteer for the Sioux County Conservation. Sioux County Conservation is NOT RESPONSIBLE for any injury, including, without limitation, physical, mental, or economic injury suffered by any person engaged in volunteer service to Sioux County Conservation, including, without limitation, injury caused by the negligence of Sioux County Conservation or any of its employees, agents or volunteers.