Brevard Zoo ADULT Volunteer Application

Please complete this application form if you are interested in becoming a Brevard Zoo volunteer. Please choose a password of at least six (6) characters to be used when you become an active Volunteer to access your schedule. Once you complete the form, click the submit button at the bottom.

General Information

First name:	*
Last name:	*
Title:
Nickname:
Street 1:	*
City:	*
State:	* Zip: *
Home phone:	OK to call me here
Work phone:	OK to call me here
Cell phone:	OK to call me here
Email address:	*
Password:
Confirm password:
Date of birth:	(year optional)
Employer:
Current School Attending:

Emergency Contact
In the event of an emergency whom should we notify?

First name:
Last name:
Title:
Street 1:
City:
State:
Zip:
Home phone:
Work phone:
Cell phone:
Relationship:

Optional Information
Providing us with the following information will help us to improve and evaluate our volunteer program and recruitment goals. It will only be used for statistical purposes.

Age:
Gender:
Education:
Ethnicity:
T-Shirt size:

Education and Employment

Volunteer Information

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
Morning:
Afternoon:
Evening:

I would like to serve up to:

hours:

Assignment Preference:

1st choice:
2nd choice:
3rd choice:
4th choice:

Why are you interested in volunteering at the Brevard Zoo?

References
Please list 2 non-family members who have known you for a least 1 year and will provide references on your ability to perform as a volunteer.

	1		2
First name:	*	First name:	*
Last name:	*	Last name:	*
City:		City:
State:		State:
Home phone:	OK to call here	Home phone:	OK to call here
Work phone:	OK to call here	Work phone:	OK to call here
Cell phone:	OK to call here	Cell phone:	OK to call here

Volunteer Agreement

Have you ever been arrested? If yes, please explain in the box, the nature of the crime and the date and nature of disposition. Conviction of a crime is not an automatic disqualification for volunteer work.
Are there any criminal charges pending against you? If yes, please explain in the box.

Volunteer Agreement
I certify that the information given by me on this application is accurate and complete to the best of my knowledge and is made in good faith. I understand that any misstatement of fact may result in rejection or termination from the volunteer program. I hearby give permission to the East Coast Zoological Society, Inc. to verify any information included in this application, including a background check if warranted. I understand that if I do not follow the Volunteer Guidelines and Rules of Brevard Zoo, I may be terminated from the volunteer program. I also give my permission for photos of me in my capacity as a volunteer to be used in any Brevard Zoo publication and on the Brevard Zoo Website.

I Agree

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