APPLICATION FOR VOLUNTEER

Name________________________________________________________________________________

Address______________________________________________________________________________

City, State, Zip________________________________________________________________________

Country______________________________________________________________________________

Home Telephone________________________Cellular Telephone______________________________

Email address__________________________________Fax____________________________________

Passport number________________________________Country________________________________

Emergency contact name_______________________________________________________________

Emergency contact telephone____________________________________________________________

At times there are situations during travel and in the jungle where a moderate amount of physical

exercise and dexterity are required.  Do you have any physical limitations that should be considered?

There are also times when we are traveling in more remote areas that are a day’s travel from a clinic. 

Do you have any medical conditions that should be known?

What are your goals or expectations of this trip?

Do you have any special talents or knowledge to share on this trip?

For volunteers working in a professional capacity, please give a brief background of your professional

credentials and work.

Will you be doing any research on this trip?________________________________________________ 

If yes, please give a brief outline of your subject and hypothesis.

Do you expect to publish this research?____________________________________________________

Will you need a letter of reference after the trip?_____________________________________________

Do you have a sponsor?_________________________________________________________________

If yes, who?___________________________________________________________________________

What languages to you speak?  Do you sign?______________________________________________

What is the approximate amount of time that you can volunteer?______________________________

If you are under 18, is there a parent accompanying you?_____________________________________

If yes, who?___________________________________________________________________________

Signature_____________________________________________________________________________

Please send to DB Peru, 440 Impala Dr., North Fort Myers, FL 33917 or email to dbperuong@aol.com