Bethel Public Library

189 Greenwood Avenue, Bethel, CT 06801

203-794-8756   Fax 203-794-8761

www.bethellibrary.org

 

 

 

 

VOLUNTEER APPLICATION

HOME DELIVERY OF LIBRARY MATERIALS

 

DATE OF APPLICATION:                                                                                                                                                                

 

NAME:  (LAST)                                                                                   (FIRST)                                                  (INITIAL)             

 

ADDRESS:                                                                                                                                                                                           

 

                                                                                                                                                                                                               



TELEPHONE:                                                                                       EMAIL:                                                                                 

 

Please provide contact information for someone we may call if you cannot be reached.

 

EMERGENCY CONTACT NAME:                                                                                                                                                   

 

EMERGENCY CONTACT TELEPHONE NUMBER:                                                                                                                   

 

Please tell us your schedule preference:

Weekly for regularly scheduled tasks                                       Occasionally for special projects                             

 

Days and times available:

 

 

Yes!  I would like to sign up to be notified by email. Check all that apply. 

 

E-mail:                                                                                                                                                                                                 

 

Please noteUnder the Freedom of Information Act (FOIA), if requested, the Bethel Public Library must disclose the names/email addresses that are provided for the purpose of receiving email fliers and newsletters.  Information provided to receive overdue notices and hold notices via email is confidential by law and is not subject to FOIA.  If you have any questions, please contact the Library Director: 203-794-8756 x6.

 


š   Children’s Programs

š   Teen programs

š   Adult Programs                                        

š   Adult Book Discussions

 

š   Adult Computer Classes

š   Hold Notices

š   Overdue Notices

š   Wowbrary – weekly email lists of new items received


VOLUNTEER APPLICATION

HOME DELIVERY OF LIBRARY MATERIALS

LIABILITY WAIVERS

 

1.       WORKERS’ COMPENSATION

 

Library volunteers who provide delivery of materials to homebound residents are not covered under the Town’s Workers’ Compensation policy because they do not meet the definition of employees of the Town. If injured, I will look solely to my own medical insurance or other insurance of mine to pay for the treatment of my injuries.

 

I understand that I am not covered by a Workers’ Compensation policy while volunteering at the Bethel Public Library.

 

Applicant’s signature:                                                                                                                                                           

 

2.       AUTOMOBILE INSURANCE COVERAGE

 

Library volunteers who provide delivery of materials to homebound residents use their own personal vehicles and are required to provide proof of personal automobile insurance coverage to be attached hereto and approved by the Library Director.

 

I understand that the Town of Bethel’s insurance does not cover me or my automobile in case of accident while delivering Bethel Public Library materials to and from homebound residents while I am volunteering at the Bethel Public Library.  I also understand that my automobile insurance will be the primary liability insurance provider and the Town of Bethel’s insurance provider will only provide excess coverage above and beyond my insurance policy limits.

 

Applicant’s signature:                                                                                                                                                           

 

Proof of auto insurance coverage provided to Library Director                            Yes                         No

 

Library Director’s Signature                                                                                 Date                                                     

 

3.       PERSONAL LIABILITY WAIVER

 

I have read and understand the personal liability waiver, below, and agree to the terms outlined therein.

 

I, for myself and for my family, heirs, assigns, successors and legal representatives, hereby waive, release and hold harmless the Town of Bethel, CT and the Bethel Public Library, their combined boards, officials, officers, representatives, employees, agents, volunteers, servants, vendors, and independent contractors from and against any and all claims, demands, losses, costs or injuries, of any kind directly or indirectly arising out of, related to, or connected with the participation by myself in the activity describe above as a volunteer for the home delivery of library materials and/or activities incidental thereto, however caused, including but not limited to the passive or active negligence of the Town of Bethel, CT and/or the Bethel Public Library, their agents and assigns.

 

Applicant’s signature:                                                                                                    Date:                                                    

 

Endorsed by the Library Board of Directors                          May 18, 2015