Your informationRequired fields are marked with an asterisk (*). One of the fields below is a file upload/attachment, the file size must be less than 10MB.
Are you a returning volunteer with Des Moines Parks and Recreation? *
Date of Birth *
A valid date as MM/DD/YYYY (for example: 11/30/2015)
Together, we grow meaningful community connections that celebrate our diversity, cultivate inclusivity, and inspire shared passion and purpose for enriching Des Moines’ quality of life.
We welcome volunteers of all abilities. If you require specific accommodations to participate, we encourage you to let us know in advance. We will do our best to provide reasonable accommodations to make your experience with us comfortable and rewarding.
To request accommodations or discuss your specific needs, please contact Parks and Recreation Supervisor, Callie Le’au Courtright at email@example.com or call 515-237-1386.
Do you have any access requirements or accommodation requests you'd like us to be aware of? *
Please feel free to list any accommodations or allergies below.
First Name *
Nickname (Preferred Name)
Last Name *
Cell Phone *
For example, 123-456-7890
Other Phone (Work, Home):
Zip Code *
Are you 18 years or older? *
I understand that I must be 16 years of age or older to volunteer in the Dog Park. *
Parent/Legal Guardian Full Name *
Parent/Legal Guardian Cell Phone *
Emergency Contact Full Name *
Emergency Contact Cell Phone *
I understand that as a volunteer with the City of Des Moines Parks and Recreation Department the knowledge I gain regarding the performance, behavior, and personal information of the Vulnerable Populations (children, elderly persons, and persons with disabilities), staff, and citizens with whom I work is confidential and I agree to respect such confidentiality.
I understand that if a child tells me something or I notice something that may indicate his/her safety is at risk or he/she is in emotional distress, I will report that information to the appropriate staff member as soon as possible.
I understand that any contact with children, volunteers, or staff beyond the boundaries of the specific volunteer activity is discouraged, is not a part of City of Des Moines Parks and Recreation programming, and will not be protected in terms of liability. This includes communication with social media.
I understand that the City of Des Moines Parks and Recreation does not discriminate on the basis of race, color, national origin, gender, disability, religion, creed, age, familial status, sexual orientation, gender identity, and ancestry in its programs and its employment practices.
I understand that submitting this information does not guarantee my acceptance as a volunteer, and that assignment of
volunteer work is based on the assessments made by the volunteer coordinator, Director, and staff.
I understand that if I have misrepresented any information and/or fail to adhere to volunteer guidelines, I may have my
application approval withdrawn.
I assume full responsibility for my actions and authorize the staff at the site I am volunteering to act on my behalf in the
event of an emergency.
I understand that the City reserves the right to complete a background/criminal check at any time.
We value and respect the privacy of individuals and the information they entrust to us. As a volunteer, you may come into contact with sensitive or confidential information about our organization, our clients, and our operations. It is crucial that we maintain the highest standards of confidentiality and safeguard this information.
Your Responsibilities as a Volunteer:
Confidentiality: You must treat all information you come across during your volunteering activities as confidential. This includes but is not limited to, personal data, financial information, and any other information not intended for public disclosure.
Data Security: Please ensure that any electronic or physical records you access or handle are kept secure and protected from unauthorized access. Do not share or store information on unapproved platforms or devices.
Limited Access: Only access and use the information necessary for your assigned tasks and related to your volunteer responsibilities.
Consent: Do not disclose or discuss confidential information with unauthorized individuals. Obtain explicit consent when required before sharing any information, even within our organization.
I have read and understand the Application and Privacy Statement and my responsibilities as a volunteer. *
I am interested in being an Ambassador at: *
Please list any past experience you have working with dogs or the public:
Dog Park Ambassadors who volunteer 40 or more hours each year, will earn a FREE Dog Park permit.
Will you be volunteering with your dog(s)? *
What is your Dog Park permit number?
What is your dog's name?
Other Interests/Knowledge/Skills/Abilities (Please select all that apply)
Do you possess a valid teaching license through the Iowa Board of Educational Examiners? *
By entering your State of Iowa current license information below, we will use your licensing background check to clear you for service.
If you have a current teaching license and have been cleared by the State of Iowa, you may ignore the background check information in the automated confirmation you receive, upon completion of your application.
Please enter your teaching license number: *
I am aware that all statements I have made and/or information I have submitted are subject to investigation and verification, including a criminal background check.
I understand that any withholding of information or misrepresentation of any statements I have made and/or information I have
submitted could result in disqualification or termination of volunteer service.
I understand that I am responsible for informing the City of Des Moines of any changes to the information above and that
failure to do so will be grounds to terminate my role as a volunteer.
I understand any offer of City of Des Moines volunteer positions is conditional upon satisfactory background checks, which
include criminal, sex offender, and if applicable, driving record; or any other that are deemed necessary by the City.
I hereby certify that all statements made and information submitted applicable to volunteering with the City of Des Moines,
Iowa are true and contains no misrepresentations to the best of my knowledge.
I understand a record of arrest or conviction does not necessarily prohibit me from volunteering and depends on the nature of
the offense, the type of service performing, and how much time has passed since the arrest or conviction. Expungement of a
conviction record or a deferred judgment does not eliminate the need to disclose those details on this form. This information
will be held in confidence, subject to Iowa Code Chapter 22, used only to evaluate applications, and only to the extent
permitted by applicable law.
I hereby consent to the City of Des Moines to request information pertaining to my criminal history. I authorize the investigation of all statements contained herein. *
I hereby consent to the City of Des Moines to request information pertaining to my minor child's criminal history. I authorize the investigation of all statements contained herein. *
Please Note: The term “convicted” includes a conviction following a trial, a guilty plea, a plea of nolo contendere or no contest,
a deferred judgment or adjudication, and an adjudication of guilt or delinquency as a minor or adult. A conviction will not
necessarily disqualify an applicant from volunteering.
If you fail to report a conviction, you may be ineligible for volunteering
regardless of the nature or seriousness of the crime and regardless of the date of the conviction.
Have you ever been cited/fined/arrested for, charged with, or convicted of a criminal offense other than a minor traffic violation? *
Briefly explain your charges and provide dates for the offenses.
Has your minor child ever been cited/fined/arrested for, charged with, or convicted of a criminal offense other than minor traffic violations? *
Briefly explain your minor child's charge(s) and when it/they occurred. *
Have you ever been listed on any sex offender registry? *
Has your minor child ever been listed on any sex offender registry? *
Have you ever been named in a founded case of child abuse or is there a current child abuse case pending against you? *
Has your minor child ever been named in a founded case of child abuse or is there a current child abuse case pending against you? *
I understand that if I'm applying for a position that requires driving a vehicle or equipment, I will be required to submit a copy of a valid driver's license. *
Has your driver's licensed ever been suspended or revoked for any reason? *
Do you have a clean driving record for the past three (3) years? *
I hereby certify that all statements made and information submitted applicable to volunteering with the City of Des Moines, Iowa are true and contain no misrepresentation. *
I hereby certify that all statements made and information submitted, on behalf of my minor child, applicable to volunteering with the City of Des Moines, Iowa are true and contain no misrepresentation. *
Do you accept and agree to the attached Permission to Participate, Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement and Photo Release? *
In consideration of me, or my minor child, being permitted to participate in any way in the above-named Volunteer Program, I, the Undersigned, for myself and my minor child, all of my or my minor child's, personal representatives, executors, administrators, heirs, next of kin, successors and assigns, herein referred to as "Releasors", do hereby:
1. Acknowledge that this volunteer service carries with it the potential for serious injury, death and/or property damage, and certify as to my physical fitness and that of my minor child to participate and declare that neither I, nor my minor child, have been advised otherwise by a qualified medical professional.
2. Acknowledge, agree, and represent that I and my minor child will, at all times, be aware of the surroundings during the volunteer service and agree that if I or my minor child consider anything related to this Activity to be unsafe, will immediately advise the Activity officials of such, and if necessary, will leave the area or refuse to participate further in the volunteer service.
3. Waive, release and discharge, and covenant not to sue, the City of Des Moines, Iowa, its elected and appointed officials, employees, volunteers, sponsors, partner organizations and agents, including others who give recommendations, directions, or instructions as part of this volunteer service, hereinafter referred to in this document as "City", from any and all liability to Releasors, except for my minor child, for any and all loss or damage, and any claim or demands therefore, on account of injury to the person or property, or resulting in my death or that of my minor child, including but not limited to illness or damage to me or my minor child’s property arising out of or related to the volunteer service, including traveling to or from the volunteer service and before, during, and after the volunteer service.
4. Agree to Indemnify and Save and Hold Harmless the City and each of them from any loss, liability, damage, or cost to third parties that they may incur arising out of or related to me or my minor child’s participation in this volunteer service.
5. Assume full responsibility for any risk of bodily injury, including but not limited to illness, death or property damage arising out of or related to the volunteer service. I agree to comply with all applicable safety rules, including wearing protective clothing, close-toed shoes/boots, safety goggles, gloves, and vest while performing my volunteer activities.
6. Agree that this Permission to Participate, Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement and Photo Release extends to all acts of negligence by the City, but excluding willful, wanton or reckless conduct, and is intended to be as broad and inclusive as is permitted by law including any governmental immunity afforded the City by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
7. Authorize any medical treatment, including the administration of anesthesia, deemed advisable by any licensed physician and/or Emergency Responder (EMT) to relieve any injuries received or illness contracted by me or my minor child as a participant in this volunteer service. I hereby agree to pay all costs of any medical treatment or emergency transportation.
8. Authorize and consent to the City, its sponsors, and any news media, and their successors and assigns and those acting under their authority, to take, publish, use for public display in any media now or hereinafter known and including without limitation on the City’s social media accounts, and copyright photographs, videotape or other audio or visual media, including broadcast in any media, of me or my minor child, including but not limited to those that capture me or my minor child’s name, voice, and/or image, and agree that such may be used for any lawful purpose without limitation or reservation and without further compensation or approval.
I have read the Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release, fully understand its terms, understand that I have given up substantial rights of my own and of my minor child by signing it, and sign it voluntarily without assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the fullest extent permitted by law, including all acts of negligence by the City as stated above. I agree that this Permission to Participate, Release and Waiver, Assumption of Risk and Indemnity Agreement and Photo Release will be IN EFFECT for 5 YEARS from the date of my signature and/or electronic submission, unless otherwise terminated by me in writing delivered to the City.