Please complete all fields
First name:
Initial: Last Name:
Nickname:
Address
City:
State: Zip:
Home Phone:
Work Phone:
Birthday:
Email Address:
Check this box if you are a member of The Living Desert
Membership #:
Expiration Date:
Select the days of the week when you are able to volunteer:
Wednesday
Saturday
Sunday
Indicate your hours of availability:
10am-1pm
1pm-4pm
ZOOTEENS commit to one 3 hour shift each week
Which months of the year are you available?
January
February
March
April
May
June
July
August
September
October
November
December
Please list all current and prior volunteer experience in the space below. Indicate organization(s) and types and length of volunteer service, including supervisor contact information:
Please list your special skills, hobbies, hidden talents and areas of expertise in the space below:
Parent / Guardian
Name:
Home Phone/Cell:
Emergency Contact
Physician
Phone:
Dentist
Date of last Tetanus Booster:
Allergies:
Name of Health Insurance Carrier:
