Volunteer Registration – Texas Wildlife Rehabilitation Coalition

Today's Date*
Date Format: MM slash DD slash YYYY
Applicant Name*
Prefix First Last
Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Home Phone
Mobile Number*
Date of Birth*
Date Format: MM slash DD slash YYYY
Emergency Contact Information
Name*
First Last
Relationship*
Cell or Best Phone#*
Occupation or School
Additional Information
How did you hear about us?*
- Family or Friend
- TWRC Website
- TWRC Volunteer
- Social Media (Facebook, Twitter, etc..)
- Search Engine (Google, Yahoo, Bing, etc..)
Please select your preferred Volunteer location*
- Animal Care Program Registration
- TWRC Main Center Registration
TWRC Volunteer Waiver
VOLUNTEER WAIVER
I, the undersigned, acknowledge that as a volunteer of TWRC, I may be exposed to certain risks inherent in working with wildlife, including but not limited to the following: bites, scratches, zoonotic diseases, including but not limited to rabies, Rocky Mountain spotted fever, Chlamydiosis, leptospirosis, brucellosis, Lyme disease, arbovirus encephalitis, tularemia, salmonellosis, and spirochaetal relapsing fever.

Individuals who volunteer with TWRC and its activities do so of their own free will and at their own risk. Volunteers acknowledge that they are assuming all risks associated with volunteer service, including risk of injury. In the event of personal injury, volunteers would be responsible for the full expense of any medical care or attention as well as other harm or expenses arising out of such injury.

The undersigned further acknowledges that he or she (1) has carefully read the foregoing release and accepts any risks involved in participation as a volunteer, and (2) has no physical impairment that would preclude participation.

This release contains the entire agreement between the parties hereto.
Check box to accept the Volunteer Waiver*
- I understand and accept the Volunteer Waiver!
Parent/Guardian
First Last
(required if Applicant is under 18 years of age)
REGISTRATION COST:
Total
$0.00
Credit Card*
American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Emergency Contact Information

Additional Information

TWRC Volunteer Waiver

VOLUNTEER WAIVER

REGISTRATION COST:

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