Thank you for applying. Please note that volunteers must be at least 17 years of age.
First and Last Name:
D.O.B./Age
Street Address
City:
State:
Zip:
Home Phone:
Work Phone:
Cell phone:
Email Address:
Employer/Job Title:
May we contact for reference:
Yes
No
N/A
If yes, please provide name and phone # of employer:
Allergies or physical restrictions:
How did you hear about the Pocono Wildlife Rehabilitation & Education Center?
Do you have any special skills that may be valuable to the Center?
Do you work with any other rescue/rehabilitation organizations?
Yes
No
If so, please give contact information for that organization including name and phone #:
Animal Experience: (check all that apply)
Veterinary Hospital
Boarding Facility
Foster Home
Dog Grooming
Cat Grooming
Shelter Work
Training/Obedience
Pet Sitting
Farm Animals
Other
If you would like to comment more on your experience with the above, please do so here:
If you listed other, please explain:
Other Experience, Special Skills, Strengths, Talents: (check all that apply)
Computers
Management
Crafts
Graphic Arts
Woodwork/Carpentry
Painting
Photography
Writing
Secretarial
Fundraising
Other
If you would like to comment more on your experience with the above, please do so here:
If you listed other, please explain:
Volunteer Work Preferences: (check all that apply)
Feeding/Cleaning
Clerical/Office
Computer/Website
Special Events
Educational Programs
Community Outreach
Other
When are you available to volunteer? (check all that apply)
Weekdays
Weekends
Evenings
Reference #1 (Name, phone # and relationship to self)
Reference #2 (Name, phone # and relationship to self)
Any additional comments:
In case of emergency, who should we contact? (name and phone #)
WHEREAS The Wilderz at Pocono Wildlife, Inc. (hereinafter referred to as The Wilderz) is a Pennsylvania nonprofit Corporation located at 1161 Cherry Drive, Stroudsburg, PA 18360 and as such performs valuable services; and WHEREAS financial claims or lawsuits against The Wilderz, it's employee or members, would discourage and possibly discontinue the valuable services provided by this organization and organizations like it, and WHEREAS The Wilderz leases said property without financial or other gain, THEREFORE I accept on behalf of myself, heirs, beneficiaries, assigns, agents, child or children, wards and conservatees, or any and all of them, any and all danger (s) and resulting pesonal injury (including death) and/or property damage and I knowingly execute the following Release of Liability after having read and understood the terms thereof.
RELEASE OF LIABILITY: This Agreement is entered into in consideration for access to premises under control of The Wilderz and the opportunity to learn about wildlife rescue and rehabilitation through participating in volunteer activities associated with The Wilderz, I. on behalf of myself, heirs, beneficiaries, assigns, agents, child or children, wards and conservatees , or any or all of them, do hereby release and discharge The Wilderz, together with the assignees, directors, officers, agents, employees, members, officials, heirs or any or all of them and their successors from any and all liability, whatsoever the nature or kind, arising out of, as a resujlt of, or in connection with said volunteer activities and/or activities occurring on premises under the control of The Wilderz. I, on behalf of myself, hereby release and discharge The Wilderz and its Directors and Officers, together with the assignees, agents, employees, members, officials, heirs or any or all of them and their successors, from any and all incidental, or indirect, special or consequential damages, including, but not limited to the loss of salary or wages or loss of opportunities, of whatsoever nature or kind arising out of, as a result of, or in connection with said volunteer activities occurring on premises under the control of The Wilderz. This Release of Liability contains the entire agreement between the Wilderz and me and supersedes any previous understanding, commitments, or agreement (oral or written) with respect to the subject matter hereof. This Release of Liability and the interpretation thereof shall be governed by the laws of the Commonwealth of Pennsylvania.
By writing your name here, you are agreeing to the above liability waiver.
By writing your name here, you are stating that you are the parent/guardian of the above applicant and you grant your permission for them to volunteer with The Wilderz at Pocono Wildlife.
Anything else you would like to say, please note it here:
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