Organization (if applicable)
Contact Name
Street Address
City, State, Zip Code
Phone Number
Email Address
How many people are in your group?
What type of project would you like to perform? Select all that apply or none if you have something else in mind.Park Cleanup
Trail Cleanup
Park Shelter Upgrade
Invasive Plant Removal / Wildflower Bed Management
Flower Planting (Spring)
What type of project do you have in mind? Be as specific as possible and include your (your group's) interests and skill level.
When would you like to perform your project? What days and hours are you available for volunteer work?
Driver's License Number
Have you ever been convicted of a felony?Yes
By submitting this form, I authorize my former employers and school authorities to give any information regarding my employment, together with any information they may have regarding me whether or not it is on their records. I authorize the City of Portage to conduct a criminal record investigation and driving record investigation. I hereby release them and their organization from any damage whatsoever for issuing same. I understand this is not a compensatory position, nor a promise of one. Furthermore, I understand that as a volunteer, I am not able to collect benefits including, but not limited to, Workers' Compensation. I acknowledge that I am volunteering my time and when this arrangement is no longer desirable by either party, either the City of Portage or myself may terminate this relationship.
Applicant's Signature (eSign by typing name)