Intern APPLICATION

PERSONAL INFORMATION DATE______

NAME______CIRCLE ONE: M F (first) (last)

ADDRESS:______

TELEPHONE:______AGE:______BIRTHDATE:______

EMAIL ADDRESS:______

INTERESTS What is your Major? ______

What course or subject area are you interning for? ______

AVAILABILITY a. How many hours is your internship?

b. What days of the week and times are you available?

EDUCATION - Are you currently in school? If yes, what school do you attend and what grade are you in?

If no, where did you attend school and what degree(s) do you hold?

EXPERIENCE a. Please list any work experience or skills you have:

______

______

______

Do you have any limitations or conditions that you feel we should know about? If yes, please explain:

What are your goals in volunteer at the Chico Creek Nature Center?

______earn school credit / fulfill a school requirement ______to learn more about Bidwell Park

______to learn about caring for animals/wildlife

Other ______

______

How did you learn about volunteering at the Chico Creek Nature Center? (please circe)

Craigslist, our website, at CCNC, from a teacher, from a friend or family member, other ______

Is there anything else you would like to tell us about yourself?

REFERENCES

Please list two references. One may be a personal reference. Please do not list any family members.

1.) NAME______RELATIONSHIP______(first) (last)

MAILING ADDRESS: ______

______

DAYTIME PHONE NUMBER:______

2.) NAME______RELATIONSHIP______(first) (last)

MAILING ADDRESS: ______

______

DAYTIME PHONE NUMBER:______VOLUNTEER RELEASE FORM

I,______, the undersigned, hereby waive, release, and discharge any and all claims for damages or death, personal injury, or property damage which I may have or which may occur to me or my property as a result of my participation in the volunteer program conducted in the Chico Creek Nature Center or on its grounds, located in Bidwell Park, Chico, California.

This release is intended to discharge in advance the sponsor of this program, the Chico Creek Nature Center, as well as the City of Chico, and any of the entities’ agents and employees, from and against any and all liability arising out of or connected in any way with my participation in above said program.

I further understand that I may be using chopping or cutting tools, hand or garden tools, and handling wild and domestic animals in this program, and that it is possible that I could sustain property damage or personal injuries, serious or mortal, from the handling and use of such tools or animals. Never the less, I hereby agree to assume any and all such risks and also agree to hold harmless all the people or entities mentioned above.

It is further understood that this waiver, release, and assumption of risk is binding to my heirs and assigns.

______Signature of Applicant Date

______Signature of Parent/Guardian (if under 18) Date