EsselWorld Bird Park (EWBP) Wildlife Rescuer Form

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If you are a wildlife rescuer; (Mammals, Snakes & Birds) NOT domestic animals, kindly share your contact details, as this is a small survey to build up a database of rescuers.

Full Name *

Email *

Address *

City *

State *

Phone number *

Phone number 2 (if any)

Gender

Female

Male

Prefer not to say

Other:

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Date of Birth *

YYYY

State your experience as a rescuer *

1 Month

Less than 6 Months

Less than 1 Year

Less than 5 Years

More than 5 Years

Rescue Preference *

Birds

Mammals

Reptiles

All of the above

List the areas you can cover for emergency Bird Rescue *

Time of Operation (For example every day during evenings, only on weekends etc.)

Mornings Only (Before Noon)

Evenings Only (Post 4 pm)

Nights Only

Weekdays Only

Weekends Only

All Days of the Week (anytime)

Other:

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Are you associated with Other Wildlife NGO's / Private Organisations involved in wildlife Rescue & Rehabilitation *

Yes

If yes, please mention the name of the NGO(full name please)

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