Emergency Animal Rescue Membership Application
Date of Application___/___/____
Member information;
Name___________________________________________________________________________________
Address_________________________________________________________________________________
City______________________________________________Zip Code________________________________
If San Diego, which area? ____________________________________________________________________
Phone (H)_________________________(W)_________________________(C)________________________
E-mail___________________________________________________________________________________
SS#___________ _________ ____________
Birth Date____-_____-____ Height___________ Weight__________ Hair_____________ Eyes_____________
Employer Name & Address___________________________________________________________________
Position_______________________________ Work Days________________________Hours______________
Can you leave work for an emergency rescue? Y N Will you agree to obtain proper full uniform? Y N
Will you agree to attend scheduled training? Y N
Are you in good physical condition? Y N
List any physical limitations____________________________________________________________________
List any special training or qualifications___________________________________________________________
Have you ever been convicted of a felony? Y N
Do you have any aliases? Y N List them here___________________________________________________
Animal Handling Information
Check animals you have experience with Dogs Cats Equine Birds Livestock Wildlife Sea Animals
Exotics specify: ________________________________________________________________________
Equipment Available for Rescue Operations:
Trailers: Vehicle Type: Additional Not Listed:
2 Horse ________ Car ___________________ ____________________________
4 Horse ________ Truck __________________ ____________________________
Stock __________ 2 Wheel ________________ _____________________________
Bumper Pull _____ 4 Wheel ________________ _____________________________
5Th Wheel ______
Driver Lic.#_____________________ Exp.Date__/__/__ Class A? Y N
Car Lic.#_________________ Trailer Lic.#________________ Truck Lic.#______________________________
Level of Membership:
Active Dues are $24.00/year
Reserve Dues are $12.00/year
Junior Reserve Dues are $12.00/year
Auxiliary Dues are $12.00/year
All dues are collected on July 1st of each year.
Members joining mid-term will pay pro-rated dues, i.e., $2.00/mo for Active, $1.00/mo for all others.
Name of vehicle insurance _____________________________________________________________________
Name of trailer insurance ______________________________________________________________________
In case of emergency, please notify_______________________________________________________________
Emergency Animal Rescue Membership Waiver I, ___________________________________ (please print full name),
as an Emergency Animal Rescue member, assume full financial responsibility for and all bodily injury or death that may occur
to me personally upon any Emergency Animal Rescue business whatsoever. I also assume full financial responsibility for any
and all damage that may occur to my personal vehicle, trailer or equipment upon any Emergency Animal Rescue business
whatsoever.
Signature____________________________________________________________________________________
Date_______________________________________________________________________________________
Parent or guardian (if minor)______________________________________________________________________
Mail completed application with dues to: Emergency Animal Rescue P.O. Box 2462 Ramona, Ca. 92065
WE HAVE A "ZERO TOLERANCE POLICY." NO ALCOHOL, ILLEGAL SUBSTANCES, FOUL LANGUAGE,
PERSONS HAVING BEEN CONVICTED OF FELONIES OR FIREARMS ARE ALLOWED AT ANYTIME. THIS
APPLIES WHENEVER YOU REPRESENT EMERGENCY ANIMAL RESCUE!
