Volunteer Application Wildlife in Need Emergency Response of PA

VOLUNTEER APPLICATION

Wildlife In Need (WIN) Emergency Response of Pennsylvania, Inc.

8553 Pettis Rd., Meadville PA 16335

Date:

Date

Name

Address

City

State

Zip

County:

Date of Birth

Date

Home phone

Cellphone

Do you have text messaging?

E mail:

example@example.com

Which way is the best to contact you? (home phone, cell phone, text, email)

Medical Concerns/allergies:

What experience do you have with animals?

Please list any special skills or certifications you have that would assist WIN Emergency Response.

This question is only for volunteers applying for Capture and Transport. Are you vaccinated with pre-rabies vaccine?

Yes No Does not apply

This question is only for volunteers applying for Capture and Transport. Have you attended a rabies training program?

Yes No Does not apply

Please list two professional references:

1.

Phone

Years Known

2.

Phone

Years Known

I HEREBY ATTEST THAT THE ABOVE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE.

WIN EMERGENCY RESPONSE OF PENNSYLVANIA RESERVES THE RIGHT TO REFUSE ANY APPLICANTS AND TO TERMINATE ANY VOLUNTEER AT ANYTIME.

Signature

Clear

Date

Which volunteer position(s) are you interested in? Type yes or no.

Permitted C&T:

Wildlife Courier:

What is your availability? (Please fill in times for days that apply. Leave others blank.)

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

Anytime call to see if available:

Other::

Permitted Capture and Transport volunteers must take the Capture and Transport course online at www.wildlifeedu.com. There is a $50 fee.

Wildlife Courier volunteers must take the Wildlife Courier presentation. There is a $20 fee.

Once your application has been received and approved, you will be contacted by a WIN representative for assistance with taking these courses.

Questions? Contact Suzanne DeArment at sdearment@windstream.net