CENTRAL MS TURTLE RESCUE

Name *

First Name Last Name

Nickname/Name you go by

Street Address *

City *

County *

State *

Cell Phone Number *

Email Address *

example@example.com

Date of Birth *

(Date)

Volunteers must be at least 18 years of age OR at least 15 with parental/legal guardian permission and release of liability OR at least 12 years old with parent/legal guardian on site at all times. *

What type of volunteer work are you interested in? *

Class A Facilities - Including facility cleaning/construction, feeding, maintenance, etc. Class B Clerical - Including mail-outs, answering hotline and messages, fundraising, grant writing, website editing, etc. Type C First Aid/Temporary Housing - Providing first aid for turtles and temporary housing until turtle can be transported to CMTR. Type D Social Media - Administering, editing, or contributing to our social media content including Facebook, Instagram, Twitter, etc. Other

If you are restricted to only certain days or hours during the week, please specify

Do you have any previous experience with turtles or reptiles? If so, please specify *

Do you have any type of veterinary or medical training? If so, please specify *

Do you own your own home/property? *

If you do not own your home and plan to foster or temporarily house turtles, is your landlord in agreement?

Do you agree to a background check, at your own expense, if any? *

Is there any other information you would like us to know about you, your interests, or your experience?

If you are applying for Class C volunteerism, do you have a Mississippi Resident Small Game Hunting/Freshwater Fishing License? *

Yes (pleas provide an image of your license below.) No, but I agree to obtain one if my application is approved (License can easily be obtained for about $12 at most Walmart stores or online. No Hunter Education Course is necessary for the required Small Game Hunting/Freshwater Fishing License.) Not Applicable - I am not applying for Class C Volunteer Type

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By signing below, you are are attesting the above information is true and accurate. This application in no way binds or contracts you to fulfill any type of obligation unless selected as a volunteer submpermittee under the Administrative Possession Permit as is granted to Christina and Luke Milbourne and the Central MS Turtle Rescue by the MS Dept. of Wildlife, Fisheries and Parks.

I do hereby consent to act as a volunteer for the Central MS Turtle Rescue. I acknowledge and agree that activities performed by me as a volunteer will be performed strictly on a voluntary basis, without any pay, compensation, or benefits. I am aware of the nature of the activities to be performed as a volunteer. These activities will include, but are not limited to the duties listed on the Volunteer Form. On behalf of myself and my respective heirs and personal representatives, I agree to indemnify and hold the Central MS Turtle Rescue and all of its officers, employees, representatives and volunteers free and harmless from and against all claims, damages, losses and expenses, including attorney fees, that I may sustain while participating in the volunteer activity. I hereby release and discharge the Central MS Turtle Rescue and all of its officers, employees, representatives and volunteers from any and all claims, demands, causes of action of any nature or cause, for any such injury or damage incurred or suffered by me. I have carefully read this agreement, waiver and release and fully understand its contents. I am aware that this is a release of liability and a contract between the Central MS Turtle Rescue and myself and I sign it of my own free will.

Signature *

Clear

Date *

Date

FOR VOLUNTEERS AGE 12-17 Parental/Guardian Release of Liability ... I do hereby consent to and authorize the Minor to act as a volunteer for the Central MS Turtle Rescue. I acknowledge and agree that activities performed by the Minor as a volunteer will be performed strictly on a voluntary basis, without any pay, compensation, or benefits. I am aware of the nature of the activities to be performed by the Minor as a volunteer. These activities will include, but are not limited to the duties listed on the Volunteer Form. I agree that all volunteer activities are to be performed by the Minor at the Minor’s risk and I assume full responsibility therefore. On behalf of myself, the Minor, and our respective heirs and personal representatives, I agree to indemnify and hold the Central MS Turtle Rescue and all of its officers, employees, representatives and volunteers free and harmless from and against all claims, damages, losses and expenses, including attorney fees, that my minor child may sustain while participating in the volunteer activity. I hereby release and discharge the Central MS Turtle Rescue and all of its officers, employees, representatives and volunteers from any and all claims, demands, causes of action of any nature or cause, for any such injury or damage incurred or suffered by the Minor. Parent/Legal Guardian Signature I have carefully read this agreement, waiver and release and fully understand its contents. I am aware that this is a release of liability and a contract between the Central MS Turtle Rescue and myself and I sign it of my own free will. *

Clear

Date *

Date

CENTRAL MS TURTLE RESCUE

Signature / Release of Liability