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2. Select the type of volunteer activity you are interested in:

   1. Amphitheater Helper Program
   2. International Coastal Cleanup
   3. Neighborhood Parks
   4. Neighborhood Watch Program
   5. Senior Services
   6. Service Projects (i.e. minor landscaping)
   7. Special Events
   8. Teen Community Service Group
4. Name (First & Last Name)*
6. Street Address*
8. Zip Code*
10. Home Phone
11. Ext.
13. Cell Phone
14. Ext.
16. Email
18. Preferred method of contact:

    1. Email
    2. Home Phone
    3. Cell Phone
20. Date of birth:
    Date of birth:
22. Gender*

    1. Female
    2. Male
    3. Nonbinary
24. Ethnicity / Race*

    1. African American
    2. American Indian / Alaskan Native
    3. Asian
    4. Hispanic / Latino
    5. Hawaiian / Pacific Islander
    6. White / Caucasian
    7. Other
26. Special talents/skills:
28. Authorization to Conduct Background Check
    I the undersigned, authorize and and all inquirie as to my character, reputation and ability and release those supplying information from all liability. Such inquiries may include a criminal record check, college or high school transcripts and driver's license check. If accepted as a volunteer, I hereby comply with all rules and regulations of Wellington and the department where assigned.
30. Terms & Conditions
    I understand that volunteering for Wellington may require the taking of fingerprints and background checks, providing of other identification or certification which may include drug testing as deemed necessary by Wellington.
32. Have you ever been convicted of a crime either as a juvenile or as an adult (including misdemeanors)?

    1. Yes
    2. No
34. If yes, describe in full a summary of offenses:
36. Emergency Contact
38. First & Last Name
40. Phone:
41. Ext.
43. Relationship
45. Release of Liability
    In consideration of the furtherance of Wellington purposes, objectives and work, and in consideration of Wellington permitting me to participate as a volunteer, on behalf of myself, my heirs, executors, administrators and assigns, I hereby waive and release any and all rights and claims for damage I may have against Wellington as well as any other person connected with Wellington, their heirs, executors, administrators and assigns for any and all injuries I may suffer while performing volunteer services for Wellington or as a result thereof.
47. Junior Volunteers
    If under 18, provide parent/guardian contact information and waiver:
49. Phone
50. Ext.
52. Email
54. Parent/Guardian Name
56. E-signature (initials) of Volunteer Applicant (Initials of parent or guardian, if under 18)
58. Thank you for your interest in volunteering to create tomorrow's community today. Volunteerism is an opportunity to mentor the residents of our community while promoting positive service.
60. Please be advised that Wellington is a public entity subject to Florida’s broad public records law under Chapter 119, Florida Statutes. Most written communications, including email addresses, to or from Wellington employees and elected officials regarding city business are public records and are available to the public and the media upon request. Your email communications may therefore be subject to public disclosure. If you do not want your email address to be subject to disclosure as a public record, please do not send electronic mail to Wellington. Instead, contact the city by telephone at 561-791-4000.
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62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field