Tipp City Public Library
Application for Teen Summer Volunteer
*Teen Volunteers must be between the ages of 14-18 or entering 7th-12th grade in
August 2017. We will need help from June 1- August 4.
* Please NEATLY & COMPLETELY fill out the application and return it to the Main Desk at the
library. BE SURE TO GET PARENT SIGNATURE ON LAST PAGE. If you need extra space, use
the back of this sheet.
*If the hours and dates you are available fit our needs, you will be contacted by phone
or email to come in and meet with the Youth Services Librarian, Heidi Martin.
*APPLICATIONS DUE TO LIBRARY BY FRIDAY, MAY 26.
NAME ____________________________________ DATE ______________
ADDRESS_________________________________ CITY _______________
STATE ___________ ZIP ______________ PHONE ____________________
EMAIL __________________________________ BIRTHDAY ____________
SCHOOL _________________________ GRADE (in August) ______________
1. Why do you want to volunteer at the Tipp City Public Library?
2. Do you have any previous experience volunteering? Where? When?
3. Any special training or skills? (computer skills, work with office machines, art skills, know
foreign languages, baby-sitter training, theater arts, etc..)
HOURS YOU WISH TO VOLUNTEER:
(NOTE: Pleas mark specific times and days you’ll be available for a minimum of 2-hour
blocks of time between these days & hours: Mon.-Thurs. 10:00 a.m.-8:00 p.m.)
Day of Week
Start Time
End Time
JUNE- Mondays
Tuesdays
Wednesdays
Thursdays
JULY- Mondays
Tuesdays
Wednesdays
Thursdays
PLEASE LIST THE DATES OF ANY PLANNED VACATIONS OR CAMPS YOU’LL BE
ATTENDING:
PERSONAL REFERENCES: (provide a reference who is NOT a family member)
_________________________________ _________________ ____________
NAME
PHONE
RELATIONSHIP
_______________________________ _________________ ____________
NAME
PHONE
RELATIONSHIP
TEEN VOLUNTEER AGREEMENT
Tipp City Public Library
The Library Agrees:
• To provide you, as a Volunteer, with a safe work environment.
• To provide supervision and training by a member of the Library staff, who will answer
your questions and provide feedback regarding your work.
• To recognize your contributions as a Volunteer to the success of the Library.
As a Teen Volunteer, I Agree:
• To adhere to all Tipp City Public Library policies and procedures.
• To arrive on time and check in with staff upon arrival.
• To call my supervisor as soon as possible if I am unable to report to work.
• To dress appropriately and complete duties to the best of my abilities.
• To report volunteer hours on the volunteer time sheet.
As a Parent, I Agree:
• To encourage my teen to strive for good work habits and attendance.
• To make sure my teenager arrives on time and is picked up at the end of his/her shift.
• To emphasize the importance of my teenager’s volunteer responsibility.
In the event of an emergency, the Tipp City Public Library has my permission to arrange for
emergency medical treatment if I cannot be reached at my emergency contact numbers.
__________________________________________
Parent’s Signature
_________________________________________
Parent’s Name (please print)
_______________
Date
_____________________
Emergency Phone #
______________________________
Other Phone #
__________________________________________
Volunteer’s Signature
____________
Date
________________________________________________________________
Return completed application to or mail to:
937-667-3826 ext. 215
Heidi Martin, Volunteer Coordinator
Email: [email protected]
Tipp City Public Library, 11 E. Main Street, Tipp City, OH 45371