Ellicott Wildlife Rehabilitation Center Volunteer Application

I understand I must be at least 16 years of age to volunteer on-site at EWRC.  Volunteer projects are available for volunteers under age 16.

I understand that this form and the Colorado Division of Wildlife volunteer forms, as well as the EWRC Release of Liability form, must be completed, signed by legal guardian (if I am a minor) and returned to EWRC BEFORE beginning volunteering.  CDOW volunteer form is available by contacting EWRC or CDOW.  I also affirm that my tetanus shot is up-to-date and will provide this information as well upon request of EWRC.  
                       

Name:______________________________________________________________
                Last                                  First                                          Middle Initial
Mailing Address:_______________________________________  Apt./Unit______

City:______________________________  State:__________________  Zip______

Home: (   )_________              Work: (   )__________                        Cell: (   )______

E-mail:_____________________________________            Date of Birth:_________

Check all that apply:

___Community Service     ____Intern     ____Retired      ____Student      ____Other

Emergency contact: _________________________ Relationship:_______________
Phone: (   )____________
Do you know of any medical condition or physical limitation that may restrict your ability to volunteer?
_____Yes     _____No    If yes, please explain:_______________________________

Background

Why do you want to volunteer at Ellicott Wildlife Rehabilitation Center?_______
_____________________________________________________________________

Describe any special skills, training or education:___________________________
_____________________________________________________________________

Please describe your recent job experience/responsibility/volunteer activity:_____
______________________________________________________________________

How did you learn about Ellicott Wildlife Rehabilitation Center?
______________________________________________________________________

References:  Please provide two references from your work or volunteer history:

Name:_________________________  Title:______________  Phone:_____________