Student Volunteer Application

We welcome students ages 11 and up to apply to be a volunteer with us. We have a number of opportunities that we offer for students to help then get credit for service hours. All students under are required to have a parent or guardian fill out the authorization section.

Student Name

First Name

Last Name

Grade Level

Date of Birth

YYYY

Student Email

Student Home Phone

(###)

###

####

Student Mobile Phone

(###)

###

####

Student Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Days Available to Volunteer

Mondays

Tuesdays

Wednesdays

Thursday

Fridays

Saturdays

Sundays

Please provide the hours based on the days indicated above that you are available to volunteer

Are there specific dates you are available?

Tell us about you

Please have the student volunteer fill in this section

Why would you like to volunteer for the Long Island Science Center?

Tell us about your talents and interests:

Anything else you would like us to know about you?

Use this space to tell us about any fun facts, interesting hobbies, creative projects, or anything else you can think of you would like us to know about

Emergency Contact Information

Emergency Contact Name

First Name

Last Name

Relationship

Home Phone

(###)

###

####

Mobile Phone

(###)

###

####

Please indicate which phone is the best to reach you in the case of an emergency

Alternate Pick-up Authorization

Please provide the names and relationships of those that you authorize to pick-up your student from their volunteer activities

Name 1

First Name

Last Name

Relationship 1

Name 2

First Name

Last Name

Relationship 2

Name 3

First Name

Last Name

Relationship 3

Parent or Guardian Questions and Authorization

This section is required for all students under 18

Does your child have any allergies?

Does your child need to carry any medications that may need to be administered during their volunteer time?

Child must be able to take medication by themselves. Medication must be brought by child in the original container it was prescribed in.

If you answered yes to the question on medications please list the medications, doseage, potential side effects or reactions, or any other special instructions here.

Photo Release

I authorize LISC to have, take, and use without payment, any photographs, slides, and or video of child as needed for public relations, marketing, advertising, and or internal training purposes.

Disclaimer

I fully understand and agree to assume all risks involved in any and all duties that I perform in a volunteer capacity on behalf of or in connection with Long Island Science Center. I agree to hold the Long Island Science Center harmless for any injury(s), loss or damages which I might sustain during the course of my volunteer duties.

Check here to show you accept the terms stated above for yourself or for a minor Volunteer for which you are the parental guardian.

Enter your name here to serve as a digital signature:

The signature of a parent or guardian is required for students under 18 years of age.