Hendrix, American kestrel - Black Hills Raptor Center

First Name

Last Name

Email Address

Contact Number

Alternate Contact Number

Full Mailing Address

Include City, State and Zip code

Date of Birth

Social Security Number (needed if you are interested in giving school programs):

Emergency Contact(s) Name(s)

Emergency Contact(s) phone number

Highest level of education completed:

Positions - What type of work interests you? Leave blank those of no interest.

Construction & Building Maintenance

Painting & wood preservation

Gardens and Grounds Maintenance

Ambassador Care

Rescue and Transport Team

Educational Programs

Phone Team

Special Events (fundraisers)

Availability (please check the times you are able to volunteer):

Mornings (9 am - 1 pm)

Afternoons (1pm - 5 pm)

Evenings (after 5 pm)

Do you have other volunteer experience? If so please tell us about it.

List other organizations you are affilited with:

What leasure activites do you enjoy?

Your Occupation:

Employer:

Please list any misdemeanor or felony convictions and or felony arrests (other than routine traffic violations) you have had as an adult.

Our education volunteers often deal with the public, including many school children, so volunteers wishing to work in these types of positions will be subject to a criminal background check. Approval and commencement of Volunteer activities may not begin until a background investigation is satisfactorily completed.

I agree

By checking this box you acknowlege you have read this statement

By checking this box I am signing this form electronically and I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that my application and the information herein is, or may be, subject to an appropriate background investigation, and furthermore, I understand that should an investigation disclose untruthful or misleading information, my application may be rejected, my name removed from consideration, or my volunteer activities with Black Hills Raptor Center terminated.

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I am signing this form electronically

Date Signed