ZooTeen Volunteer Program

ZooTeen Application

Personal Information:

Please complete all fields
 
Salutation:
First Name:
Middle Name:
Last Name:
Nickname:
Birthday: (mm/dd/yyyy)
School Attending:
Grade:
 

Contact Information:
Street:
Apt. #:
City:
State/Province:
Zip/Postal Code:
Country
Home Phone: (Must include area code)
Mobile Phone: (Must include area code)
Other Phone: (Must include area code)
E-mail:
 

Other Information:
 Check this box if you are a member of The Living Desert
Membership #:
 
Indicate your hours of availability:
 10am-1pm  1pm-4pm
 
Can you commit to one full year serving as a ZooTeen?
 Yes  No
 
Please list all current and prior volunteer experience in the space below. Indicate organization(s) and types of volunteer service:
 
Please list your special skills, hidden talents and areas of expertise in the space below:
 
Parent / Guardian
Name:
Home Phone: (Must include area code)
Cell Phone: (Must include area code)
Work Phone: (Must include area code)
 
Emergency Contact
Name:
Home Phone: (Must include area code)
Cell Phone: (Must include area code)
Work Phone: (Must include area code)
 
Physician Name:
Physician Phone: (Must include area code)
 
Dentist Name:
Dentist Phone: (Must include area code)
 
Date of last Tetanus Booster (mm/dd/yyyy):
 
Allergies:
 
Name of Health Insurance Carrier: