Name: Address:

Phone: Email:

School: Grade:

In case of emergency, please call:

Parent/Guardian: Phone:

If you need service hours, explain what the service is for and how many hours you will need:

Have you volunteered before? Yes No

If so, where?

For how long?

What did you do?

As of today, when will you be available?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

As a volunteer for the Berwyn Public Library, it is expressly understood that while in the course of my voluntary activity, I hereby agree to hold the City of Berwyn, it's library, employees, agents, and officers completely harmless from and against any and all claims and liability that may be asserted because of an injury or death to myself or others or any damage to my property or the property of others arising out of my voluntary acts for the Berwyn Public Library.

Digital Signature:

Parent or Guardian Digital Signature: