Enter the name and phone number(s) for someone who may be contacted for you in the event of an emergency.

Under employer, enter either your current or most recent employer and if you are now retired.

Are you currently a member of Conner Prairie?

Please indicate the days and times you are typically available to volunteer.

The following volunteer assignments may currently be available. Others occur at various times during the year and volunteers are notified when they do. Check any areas that interest you or that you would like to hear more about.

In consideration of being allowed to participate in volunteer activities at Conner Prairie, I hereby agree to release and hold harmless Conner Prairie Museum, Inc., its officers, employees and agents from all liability for any harm or injury that I may occur as a result of participating in activities as a volunteer.

By way of this form, I authorize Conner Prairie staff to assist me by administering basic first aid (e.g. ice packs, band aids, ointments, etc.) and/or obtain appropriate emergency medical treatment for me in the event of accident, injury or illness.

In consideration of the publicity benefits to me and of my involvement by Conner Prairie, I hereby give Conner Prairie, its nominees, agents and assigns and anyone publishing under its authority ("Conner Prairie") unlimited permission to publish and republish reproductions of my likeness and voice, with or without use of my name. I hereby agree to hold Conner Prairie harmless from any liability arising from the use of my likeness, voice or name in conjunction with this agreement.

For the safety and well being of our staff, volunteers and guests, please read the following and sign (check "I agree") where indicated. You will also be asked to provide your social security and drivers license numbers for this purpose:

I authorize Conner Prairie to conduct a criminal history and driver's record check (when necessary)through Barada Associates. I release from all liability and hold harmless any person giving or receiving information about me relative to the investigation. I understand that any falsification, misrepresentation or omission of information discovered as a result of this investigation may prevent me from volunteering at Conner Prairie. I declare that I have never committed nor been charged or convicted of any act of abuse, neglect, exploitation or fraud in relationship to a dependent/vulnerable child or adult.

Indicate your consent by checking the box at the bottom of the page.