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2. Dubuque County Conservation Volunteer Application

   Please fill out the entire form. This document shall be retained by the Dubuque County Conservation Board.

4. Contact Information
6. Name*
7. Email Address*
9. Address*
11. City*
12. State*
13. Zip Code*
14. Phone Number*
16. Emergency Contact Name*
17. Emergency Contact Phone Number*
21. More About You

    Education, Special Trainings, Interest, Availability 

23. Education
    -- Select One --High SchoolCollegeGraduate School
24. Special Trainings
26. Previous Volunteer Experience
27. Type of Volunteer Work Desired *

    1. Trash Clean-Ups
    2. Environmental Education
    3. Trail Work
    4. Citizens Science

    1. Special Events
    2. Nature Center Volunteer
    3. Maple Syruping
    4. Other
29. Days & times are you most interested in volunteering. *

    1. Week Days
    2. Weekends
    3. Evenings
    4. Anytime
30. How did you learn about our volunteer program?
    -- Select One --FacebookWebsite FriendNewsletterConservation Employee
31. Your Birthdate
33. Would you be interested in volunteering at the Mines of Spain Recreation Area?*
    -- Select One --Yes (please contact me on opportunities)No

    In addition to 20+ parks, the Dubuque County Conservation Board also manages the E.B. Lyons Interpretive Center at the Mines of Spain. 

37. Volunteer Release of Liability (type signature)*

    You will now be a volunteer of the county therefore not covered by the County’s workers compensation insurance. Additionally, volunteers are not eligible for medical, dental, or related insurance coverage. Signing this document volunteers hereby grant and convey unto Dubuque County Conservation all right, title, and interest in any and all photographic images and videos made by the County Conservation Board during the Volunteers activities. If you have questions regarding how this affects you and your work as a volunteer at Dubuque County Conservation we recommend that you discuss those questions with your insurance carrier. 

    Your signature indicates that you have received this notice of non-coverage. If you have questions, you may want to discuss this Notice with your legal advisor or your insurance advisor prior to signing. 

    
    

     

39. Legal Guardian Signature (if under age of 18)
41. A representative from the Dubuque County Conservation Board will contact you.
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field