Form : Great Lakes Aquarium

Contact Information

Name*

First Last

Age*

I am 18 or over
I am under 18

Birthday*

Gender Pronoun

He/Him/His
She/Her/Hers
They/Them/Theirs
Other

If 'other,' please list:

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Information

Emergency Contact Name*

First Last

Relation to you*

Emergency Contact Phone*

Education and Training

Please fill out all that apply.

Highest Level of Education Currently Pursuing or Completed*

Do you have any specialized skills or training?

Work Experience

Please fill out all that apply.

Current or Most Recent Employer

Position Title

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary duties in this position:

May we contact this employer?

Yes
No

References

Please list two non-family references acquainted with your personality and work.

Name*

First Last

Phone*

How many years have they known you?*

Name*

First Last

Phone*

How many years have they known you?*

Volunteer Experience

Please describe any volunteer experiences or roles you have participated in during the past three years.

Additional Information

Are you a member of any clubs or organizations?

Please describe your memberships.

How did you learn about the Great Lakes Aquarium volunteer program?*

Why are you interested in volunteering at Great Lakes Aquarium?*

What do you hope to gain from your volunteer experience?*

What forms of recognition (for your volunteer contribution) are most valuable to you?*

Important - Read Before Providing Consent

For applicants under the age of 18, the following section should be filled out by a parent or guardian.

Consent*

I verify that I am the person named as the applicant on this form. I understand, answer, and agree to each of the questions in this application on behalf of myself.

Parent/Guardian Acknowledgment*

I am the parent or guardian of the applicant. I understand, answer, and agree to each of the questions in this application on behalf of the applicant.

Parent/Guardian Consent*

I have reviewed the contents of this application and consent to my child applying to the Great Lakes Aquarium volunteer program.

Participant Waiver*

I understand that I am participating in the Volunteer Program at my own risk. I will not hold Great Lakes Aquarium or its officers, directors, employees or other volunteers liable for any negligence or alleged negligence or other fault (not including intentional acts) that results in personal injury, death, or property damage during or in connection with the above program. The undersigned, for myself and for my heirs, executors, administrators and assigns, hereby release and forever discharges Great Lakes Aquarium and its officers, directors, employees, and volunteers from all such claims. The waiver will be construed according to the law of the State of Minnesota.

I have read and agree to the participant waiver on behalf of myself or my child.

Medical Release*

I hereby give my permission for Great Lakes Aquarium to procure all necessary medical help for myself, my child or ward while said person is under the direct supervision of Great Lakes Aquarium, and grant permission to its representatives to authorize any competent medical professional to do all things reasonably necessary to take care of any injury or sickness.

I have read and agree to the medical release on behalf of myself or my child.

Read the following statements carefully before you submit this enrollment form.*

I certify that all of the statements by me in this application are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that any false information or omission of information from this application may be cause for rejection or dismissal if enrolled into the volunteer program.

I understand that Great Lakes Aquarium makes no promise or agreement to enroll me for a certain period of time. If I am enrolled, Great Lakes Aquarium may terminate my involvement at any time with or without cause, for any lawful reason. Also, any Great Lakes Aquarium volunteer is free to terminate their enrollment at any time. I also understand that I will not be paid for my services as a volunteer at the Aquarium.

I have read and understand the above statements. I understand that checking this box represents my electronic signature.

Read the following statements carefully before you submit this enrollment form.*

I authorize the Minnesota Bureau of Criminal Apprehension to disclose any or all criminal history record information to Great Lakes Aquarium or its agents for the purpose of approving my application to become a volunteer. The expiration of this authorization shall be for a period no longer than one year from the date of my signature.

If there is any additional information or explanation I would like to provide in relation to my background check, I understand that I can contact the volunteer coordinator Danielle Tikalsky at dtikalsky@glaquarium.org.

I have read and understand the above statements. I understand that checking this box represents my electronic signature.

SCUBA Diving Medical History

SCUBA diving makes considerable demands on your physical and emotional condition. Diving with particular defects amounts to asking for trouble not only for yourself, but to anyone coming to your aid if you get into difficulty in the water. Therefore, it is prudent to meet certain medical and physical requirements before beginning a diving or training program. Obviously, you should give accurate information or the medical screening procedure becomes useless.

This form shall be kept confidential. If you believe any question amounts to invasion of your privacy, you may elect to omit an answer, provided that you shall subsequently discuss that matter with your own physician and they must then indicate, that writing, that you have done so and that no health hazard exists.

Should your answers indicate a condition which might make diving hazardous, you will be asked to review the matter with your physician. In such instances, their written authorization will be required in order for further consideration to be given to your application. If you physician concludes that diving would involve undue risk for you, remember that they are concerned only with your well-being and safety. Respect the advice and the intent of this medical history form.

Age

Weight

in lbs

Height

in inches

Sex

I have had problems with my lungs/breathing, heart, blood, or have been diagnosed with COVID-19.

Yes
No

I am over 45 years of age.

Yes
No

I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.

Yes
No

I have had problems with my eyes, ears, or nasal passages/sinuses.

Yes
No

I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.

Yes
No

I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease.

Yes
No

I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attackes, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning disability.

Yes
No

I have had back problems, hernia, ulcers, or diabetes.

Yes
No

I have had stomach or intestine problems, including recent diarrhea.

Yes
No

I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine/Lariam).

Yes
No

Have you ever had any other medical problems not listed? If so, please list or describe:

Participant Signature*

I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.

I have read and understand the above statements. I understand that checking this box represents my electronic signature.

Hidden Validation Field

Now Open – H2O: Watersheds at Work!

Dive Volunteer Application

Contact Information

Emergency Contact Information

Education and Training

Work Experience

References

Volunteer Experience

Additional Information

Important - Read Before Providing Consent

SCUBA Diving Medical History