Volunteer Application

Please complete this application if you are interested in becoming a Niabi Zoo Volunteer.

Applicant Information

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Cell phone:

OK to call me here

Email address:

Date of birth:

T-Shirt size:

Volunteer Information Center

This password will allow the applicant to log in to the Volgistics system.

Emergency Contact

First name:

Last name:

Home phone:

* OK to call here

Cell phone:

* OK to call here

Email address:

Relationship:

Availability

Volunteers are required to commit to a scheduled 3.5 hour shift every week or every other week for a minimum of 6 months (summer or semester if college student and must commit weekly). Please indicate the days and times you are usually available to volunteer.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

I would like to serve up to:

hours:

Please provide any additional considerations regarding your availability.

Employment

Employer name:

First name:

Last name:

Title:

Work phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

References

1

2

First name:

Last name:

Work phone:

* OK to call here

Work phone:

* OK to call here

Cell phone:

* OK to call here

Cell phone:

* OK to call here

Email address:

Relationship:

General Interest

1. Why do you want to volunteer at the Niabi Zoo? 2. What do you hope to gain from this experience?

Demographic Information

Niabi Zoo does not discriminate against race, color, religion, sex, gender, or national origin. This information will not determine whether or not the applicant will be selected for the position. This information is gathered solely for statistical analysis. This is an optional section.

Gender:

Education:

Ethnicity:

Marital status:

Preferred Pronouns:

Major degree:

Minor degree:

High school:

College:

Requirements Prior to Service

All Volunteers are required to submit to a criminal history background check and will enter their Social Security Number on a request form during the Volunteer interview. All records are kept confidential.

All Volunteers must provide a copy of valid identification (Driver’s License, State issued ID, Military ID, etc.).

Proof of a negative TB (Tuberculosis) Test is needed prior to volunteering (can get at your family doctor or medical clinic) dated within the last 6 months.

Considerations and Agreement

Assumption of Risk. – The undersigned acknowledges and understands that activities undertaken by the volunteer may involve a certain degree of risk of personal injury and injury to personal property which may result from the volunteer’s participation therein. The undersigned further acknowledges and assumes all risk of injury and/or damage to the volunteer, which may result from any reason whatsoever.

General Release. – The undersigned hereby releases and waives any claims that the undersigned may now or hereafter have against Rock Island County Forest Preserve District and Niabi Zoo, its sponsors, trustees, officers, directors, employees or its assigns from and against any and all liabilities, losses, damages, costs or expenses of whatever kind or nature, including attorney’s fees, which the undersigned may incur as a result of any injury to us or our personal property as a result of the volunteer’s activities undertaken at Niabi Zoo including, without limitation, personal injury and damages thereof including loss of income, earnings, bodily injury, pain and suffering, emotional or mental distress and any and all medical expenses.

Statement of Understanding: I understand that volunteering for the Niabi Zoo is to serve in the capacity necessary for the benefit of the Zoo first and foremost. All other reasons for volunteering are secondary to the needs of the Zoo.

I attest that all of the information provided in this application has been provided truthfully and has not been falsified in any way.

I Agree

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