Volunteer Docent Application
Please print: Date:___________________
Name:____________________________ E-mail:___________________
Day phone:________________________ Evening phone____________________
Address:__________________________ City:__________________ Zip_______
If you are under 18, please provide: Age_____ Date of Birth___/___/___
Parent or Guardian's signature: ________________________________________
Check all that apply:
Student_____ Employed_____ Retired_____ Other_____
Availability: (we request at least one shift per month)
Tues__Wed__Thur__Fri__Sat__Sun__
Mornings-9:00am-12:30pm _______________________________
Afternoons-12:30pm-4:30pm _______________________________
Sunday shift is 1:30pm-4:00pm _______________________________
Signature:_______________________________________________________
Mail or bring application to : Old Independence Regional Museum
380 S. Ninth Street/ P O Box 4506
Batesville, AR 72501/72503
Attn: Docent Coordinator