Please fill in and submit the form. All questions are required.

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PERSONAL INFORMATION

First Name:
Last Name:
Phone:
Email:
Emergency Contact Name:
Emergency Contact Phone:
Are you a Lee County BoCC employee?	Yes No
Have you retired in the last six months from the FRS?	Yes No
Have you volunteered for the Lee County Library System before? If yes, what location?	Not a Prior Volunteer Bonita Springs Cape Coral Captiva Dunbar East County Fandom Fest Fort Myers Johann Fust Lakes North Fort Myers Northwest Pine Island Reading Festival Riverdale South County
IP

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SHIFT SELECTION

Select all shifts you are available to work.

Saturday, Dec. 13 - 10 a.m. to 4 p.m. (6 hours) Saturday, Dec. 13 - 10 a.m. to 2 p.m. (4 hours) Saturday, Dec. 13 - Noon to 4 p.m. (4 hours)

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WORKERS' COMPENSATION FOR VOLUNTEERS

Volunteers may be covered under Lee County’s Workers’ Compensation Program for work related injuries which occur while a person is volunteering. The insurance is managed by Lee County Risk Management with specific policies and procedures. Please review the procedures on the county website. If you have questions, please contact the Volunteer Coordinator at 239-533-4894.

In all cases, the person in charge should be notified immediately.

I understand the policies and procedures for reporting and seeking medical treatment for on-the-job injuries and accidents while volunteering for the Lee County Library System. I understand that if I do not follow these procedures benefits may be denied and/or may be personally liable for expenses incurred.

Please Select One Yes, I acknowledge and understand. No, I do not agree.

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PHOTO RELEASE

I agree to allow myself to participate in and to be photographed or videotaped for publication purposes involving the Lee County Library System or events.

I give the Lee County Library System the absolute right to use, re-use and publish without restriction photographic pictures and/or video of myself for art, advertising, or other purposes, including but not limited to, public service announcements, department brochures, and other programs shown to the general public.

I also consent to the use of any printed matter in conjunction therewith.

Please Select One Yes, I consent. No, I do not consent.