Teen Volunteer Interest Form

Volunteer opportunities for teens, ages 14-17. Please complete all sections.

Personal Information

Date

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

Email Address

Which School do you attend?

How old are you?

Library Preference & Availability

Library Preference?

Cedaredge

Crawford

Delta

Hotckiss

Paonia

Literacy

Are you volunteering for school credit

Yes

If so, how many hours do you need?

Days/Times Available

Please select the days and timeframe you would be available to volunteer. Enter any additional information in the comment area.

Day	All day	From	To	Comment
Sunday	Time	Time	A Comment for this time slot	Add time slot Clear Copy last day
and	Time	Time	A Comment for this time slot	Clear
Monday	Time	Time	A Comment for this time slot	Add time slot Clear Copy previous day
and	Time	Time	A Comment for this time slot	Clear
Tuesday	Time	Time	A Comment for this time slot	Add time slot Clear Copy previous day
and	Time	Time	A Comment for this time slot	Clear
Wednesday	Time	Time	A Comment for this time slot	Add time slot Clear Copy previous day
and	Time	Time	A Comment for this time slot	Clear
Thursday	Time	Time	A Comment for this time slot	Add time slot Clear Copy previous day
and	Time	Time	A Comment for this time slot	Clear
Friday	Time	Time	A Comment for this time slot	Add time slot Clear Copy previous day
and	Time	Time	A Comment for this time slot	Clear
Saturday	Time	Time	A Comment for this time slot	Add time slot Clear Copy previous day
and	Time	Time	A Comment for this time slot	Clear

Hours Per Week

References & Emergency Contact

References: Please list two adult references who are NOT your relatives. References may be teachers, friends, ministers, youth leaders, coaches, etc.

Reference One Name

Relationship

Email Address

Phone Number

Reference Two Name

Relationship

Email Address

Phone Number

Emergency Contact Name

Relationship

Phone Number

Why do you want to volunteer at the library and what do you hope to gain from this experience?

Please list your hobbies, interests, clubs, or other information you would like us to know about you:

How do you use the library (homework, information, recreational reading, etc.)?

Photo Release

I give permission for my child to be photographed and/or videotaped in their role as a teen volunteer at Delta County Libraries for the sole purpose of non-commercial educational and/or promotional use, and I understand that I am not entitled to compensation for this service.

Signature of Parent or Guardian

Parental Permission

I give my child permission to volunteer for Delta County Libraries.

Signature of Parent or Guardian:

Please sign below when you have read and understood all statements.

I certify that all statements made in this Volunteer Application are true and correct and have been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, and I release Delta County Public Library District from any liability for supplying such information.
I understand that the Delta County Public Library District reserves the right to screen volunteers and will not accept as a volunteer anyone who would jeopardize any aspect of library service or safety of library staff and patrons.
I agree to give prior notification to the Library if I cannot keep my scheduled date and time of service.
I understand that I will not be paid for my services as a volunteer, and I am giving my time freely to the Delta County Public Library District.
I understand that by volunteering, I am not guaranteed any special consideration for any future permanent job positions with the Delta County Public Library District.

I understand and agree to the terms listed above (please sign).

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