Welty Environmental Center

Volunteer Application Form

Name:

Address:

Phone:

Email:

Week Days Available:

Times Available:

I prefer to volunteer:

__Weekly   __ Monthly   __ As Needed    __Other, explain_______________________

Please check the areas of interest.

Volunteer Registration and Release Form
I understand that my services are being offered on a voluntary basis without anticipation of financial compensation. I grant permission for my photo to be used in any promotional materials produced by the Welty Environmental Center. I shall indemnify and hold harmless the Welty Environmental Center, its Board of Directors, commissions and their officers, agents and employees from and against all claims, demands, loss of liability of any kind or nature for any possible injury incurred during volunteer services.

Signature of Volunteer:________________________________________________________  Date:___________

Signature of Parent/Guardian: __________________________________________________  Date:____________
(if volunteer is under the age of 18)

Please return the completed form to:
Welty Environmental Center
8606 W. County Rd. H
Beloit, WI 53511
608-361-1377
www.weltycenter.org

How did you learn about the volunteer opportunities available at the Welty Environmental Center?

__Newspaper     __WEC Website     __Beloit College     __Friend    __Other:________