Name:

Phone Number: Home.( ) Cell. ( ) Work. ( )

Address:

City, State, Zip:

E-mail Address:

Have you had any previous experience (volunteer and/or employee) with any rescue group or animal shelter? Please explain:

Do you have any professional experience (i.e. vet tech, veterinarian, trainer, groomer, etc.) working with animals? Please explain:

Tell us why you would like to volunteer at CARE:   

Please list your pets that you currently own?

PETS NAME 1: Age: Breed: Spayed/Neutered?

Behavior Issues:

PETS NAME 2: Age: Breed: Spayed/Neutered?

Behavior Issues:

PETS NAME 3: Age: Breed: Spayed/Neutered?

Behavior Issues:

Other pets' Veterinarian’s name and phone number:

Days/Time Available:

Sunday TO Monday TO Tuesday TO Wednesday TO

Thursday TO Friday TO Saturday TO

Any Physical Conditions Please Describe:

Allergies

Medical Conditions

Physical Restrictions

Date of Last Tetanus

In Case of Emergency Contact:

Name:

Address:

City/state zip:

Phone Numbers Home: Cell: Work:

INSURANCE WAIVER

The undersigned Volunteer and the Center for Avian Rehabilitation & Education, Inc. (CARE, Inc.) enter into the following binding Agreement:

Volunteer understands that CARE, Inc. makes no warranty as to age, health, breed, habits and/or disposition of the birds housed at the Center and completely and fully releases CARE, Inc. from any liability for any injury or damage that any animal on the premises and/or any remote location could inflict upon any person or property, and for any illness of the animal or for the transmittal of any illness or parasite to any other pet or person.  Volunteer further indemnifies and holds harmless CARE, Inc. for any actions, suits, fees and/or expenses (including actual attorney’s fees) arising out of any injury from an animal on the premises of CARE, Inc. and/or any remote location.  You will have to sign this form when you come in for your training.

Signed_____________________________________________________________________ Date __/__/____

3053 Beechwood Ind. Ct., Suite 1 ● Hubertus, WI 53033 ● 262-628-3719 ● www.centerforavianrehab.org ● cntrforavianrehab@sbcglobal.net