Volunteer

Name*

First Last

Organization

Email*

Phone*

Are you over 18 years of age?*

Yes
No

Please note that children of all ages are allowed to participate in every KPWB program, but volunteers under the age of 16 need to be accompanied by a guardian for the entirety of the activity. Volunteers under the age of 18 do not need to be accompanied, but will require the signature of a guardian on their initial waiver of liability.

Street

City

State

Zip Code

Prince William County District of Residence

I am interested in the following (Select all that apply.)

Select All
Community Cleanups
Beautification
Storm Drain Labeling
Litter Surveying
Plastic Recycling
In-Office Support
Educational Support
Internship/Eco-Ambassador Program

Emergency Contact Name and Number*

Do you have any medical conditions that could affect volunteering?*

How soon are you looking to volunteer?

By checking this box, I confirm that I understand KPWB will send me emails pertaining to upcoming volunteer opportunities and I may opt out of these notifications at any time per my own request.*

I agree

By checking this box, I confirm that I understand a member of the KPWB staff will contact me to schedule an in-person orientation during which I will be asked to sign a waiver of liability.*

I agree

Language Preference*

English
Spanish

KPWB wants to know how to best communicate with you during your volunteer orientation. Please let us know if you may need any other assistance for your orientation.

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