GENERAL VOLUNTEER APPLICATION

WIN VOLUNTEER APPLICATION

Wildlife In Need Emergency Response of Pennsylvania
What WIN Volunteer Opportunity are you interested in? Check all that apply.

Capture & TransportWildlife CourierDispatcherNot Sure
Please let us know how you learned about WIN:
Personal Referral? Who should we thank?:__________________________________________
Social Media? Face Book X/Twitter InstaGram YouTube
Event Table (Please mention event): ____________________________________________________________________________________
Other (Please specify):
_____________________________________________________________________________________
Name:

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState/Province & County

Postal / Zip Code
Date of Birth
E-mail*
example@example.com
Cell Phone Number*
Cell Carrier *

Preferred contact method. Check all the apply.

TEXTEMAILCELL PHONE
List Medical Concerns, including Allergies
List two professional references, including contact information and years known.
(For Capture & Transport Applicants Only) Are you vaccinated with pre-exposure rabies vaccine?

YESNONO, but I plan to become vaccinated.
(For Capture & Transport Applicants Only) Have you attended a rabies training program?

YESNO
What experience do you have with animals?
What experience do you have working with the public via phone or in-person?

Do you have any special skills or certifications that you feel are relevant to helping WIN?
In general, what days of the week are more available to respond to assignments? (Check all that apply) WIN will work with you to identify your specific availability.

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
With respect to the above days of availability, please provide below any guidance you can about hours of availability.
I hereby attest that the above information is true to the best of my knowledge. WIN reserves the right to refuse any applicant and to terminate any volunteer at any time.

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WIN VOLUNTEER APPLICATION