Clearwater Marine Aquarium
249 Windward Passage, Clearwater, FL 33767
727.441.1790 x258
VOLUNTEER APPLICATION
Please complete all parts of this application legibly (please print clearly). Incomplete forms will not be
considered.
Name (Last/First)
_____________________________________________
Street Address
_____________________________________________
City/State/Zip
_____________________________________________
Date of Birth
__________________________
Home # ____________ Cell# _______________ Work# ________________
Best time to reach you:
_____________________ Home/Work/Cell (circle one)
E-mail:
_______________________________________________
VOLUNTEER RELEASE:
By signing this application, you (and your parent/guardian if you are under age 18 yrs.) are
indicating that Clearwater Marine Aquarium, Inc., assumes no responsibility for any injury
suffered by you as a result of your volunteer work either on or off Clearwater Marine
Aquarium premises, and if you are accepted into the Clearwater Marine Aquarium Volunteer
program, neither you, nor your parent/guardian, nor heirs, administrators, executors, and
assigns shall ever institute any action at law or otherwise against Clearwater Marine
Aquarium as a result of any injury to you or your property resulting from your volunteer
services, and you and your parent/guardian, for yourselves and your heirs, administrators,
executors, and assigns HEREBY RELEASE CLEARWATER MARINE AQUARIUM, its Board
of Directors, Officers, employees, and agents from and against any and all claims for
personal injury to you or loss or damage to your property arising out of your activities
undertaken as a volunteer. I understand that CMA will run a background legal check on me
since I will or may be in contact with minors.
Executed this ____ day of ______________, 20___.
__________________________
Your signature
____________________________
Parent or Guardian (if volunteer under age 18)
EMERGENCY CONTACT INFORMATION
Name: _________________________
Relationship: ________________________
Phone numbers: ___________________________________________________________
TWO REFERENCES:
Contact Names: 1. _____________________
Phone# : _______________________
2. __________________________
__________________________
What days are you available to volunteer? Mon. Tues. Wed. Thurs.
What is your shirt size? (circle one) Small Medium Large XL XXL
Why do you want to volunteer?
Fri.
Sat. Sun.
Have you ever volunteered at CMA before? If so when did you volunteer and in which dept?
Describe any prior volunteer experience.
What is your education level and area?
Describe any physical limitations we should be aware of.
List any appropriate certifications.
(ex. SCUBA)
Employment
Employer’s name?
How long have you been employed with this company?
May we contact your employer?
Supervisor name & phone:
Work schedule:
Vehicle
Year:
Make:
Model:
Color:
License Tag #:
State:
CRIMINAL HISTORY
An applicant found to have been convicted of, or having charges pending for a felony or
misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose
risks to children or the CMA Program’s credibility will not be accepted as a CMA volunteer.
Applicants with other misdemeanor or felony charges or convictions that would not pose a
risk to children or negatively impact the credibility of the CMA Program will be considered on
a case by case basis considering the time passed since the incident and the level of
rehabilitation.
Have you ever been arrested for a crime?
Yes ____ No _____
If yes, what was the charge?
__________________________________________________________________________
Date of arrest/Disposition: __________________________ County: ___________________