Wildlife Jewels® EYES Community Reporter Submission Form

Wildlife Jewels® EYES Community Reporter Submission Form

Wildlife Jewels® | 501(c)(3) public charity | www.wildlifejewels.org
Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number*
Confirm your Role::*

Community Reporter
Select Your Primary Wildlife Jewels® EYES Site(s)::*

EYES Ventura BeachEYES Newport BeachEYES Crystal Cove BeachEYES Huntington BeachEYES Solana BeachEYES La Jolla CoveEYES La Jolla Children's PoolOther
Type of Distressed Wildlife You're Reporting:*

Marine MammalBirdFishOther
If known, what species?*

Brown PelicanGullSea LionSealDolphinWhaleOther
Condition of wildlife:*

Thin/emaciated (visible ribs, hips, or spine)Entangled in fishing gearVisibly injured or bleedingIsolated and not movingDeceasedOther
Date wildlife was last seen:*

MonthDayYear
Date
Time wildlife was last seen:*

Hour Minutes

AM/PM Option
Please provide the exact address, GPS Pin, or a clear description of where the distressed wildlife was was last seen:*
At most two sentences.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Click on the map to place a pin at the exact location where the wildlife was seen. You can drag the pin to fine-tune the location. to the location of wildlife last seen?
Threats: Did you observe any of the following threats to wildlife?*

Unleashed dogs on the beachDogs on the beach (where not allowed)Visibly injured or bleedingPeople feeding wildlifeCars, bikes, or e-bikes racing byOil, tar balls, or chemical slicksFishing in unauthorized areasI did not see any visible threat to wildlifePeople chasing or throwing objects at wildlifeOther
Debris: What type of debris did you find? (Optional)

Plastic debris, bottle caps, plastic strawsCandy wrappers and utensilsStyrofoam either large and smallCharcoal or burnt woodPlastic bottles and cupsOther
Debris: How much debris did you observe? (Optional)

A few peicesManyBags full
Please upload clear photos or videos to help us assess the situation. If injured wildlife is found, include: A close-up showing the animal’s condition or any visible injuries. A wider shot showing the animal in its environment or the exact location.If you're reporting debris or threats, include photos of the surrounding area and specific items of concern. Clear visuals help our rescue team respond more effectively and ensure appropriate action is taken.

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I agree the position of (Community Reporter) at (Wildlife Jewels®) is a volunteer position. This means that, if you accept the role, you perform all duties on a voluntary basis and you will not receive remuneration or payment for your reports.

I confirm that I am over the age of 18. I understand that I am volunteering independently as a community reporter for the Wildlife Jewels® EYES Collective and not acting on behalf of Wildlife Jewels®. I’m reporting on my own time and am not performing rescues or handling wildlife.

I understand there are risks involved with wildlife observation and beach visits, and I take full responsibility for my participation. Wildlife Jewels® is not liable for any injury or damages resulting from my activities.

I give Wildlife Jewels® permission to use any photos or videos I submit for educational, advocacy, or promotional purposes, and I consent to the use of my image in related materials.

By submitting this form, I agree to receive occasional updates and confirm that I accept these terms and conditions.

I hereby release and hold harmless Wildlife Jewels® from any claim or lawsuit for personal injury or property damage arising out of participation in the Event, including both claims arising during the activity and after I complete the activity.
I agree to the Terms & Conditions
All content © & ™ Copyright Wildlife Jewels® 2025. All rights reserved. Wildlife Jewels® is a registered trademark of Wildlife Jewels®.
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