STAFF RECOMMENDATION FORM (Page 2 of 2)

Comments on ratings: _____________________________________

How long have you know applicant? __________ In what capacity?________________________________________________

Please give any further information which would be helpful to the Directors in appraising the applicant. (use back of form.)

Would you feel comfortable with this applicant caring for your child in a camp setting?    YES     NO    (please circle one)

Date: __________________ Name:___________________________

Position:_____________________________

Address: __________________________________   Phone:(   ) ______________
            __________________________________

PLEASE RETURN COMPLETED FORM TO THE ADDRESS BELOW

 Ellijay Wildlife Rehabilitation Sanctuary
435 Cougar Lane
Ellijay, Georgia 30540
(706) 276-2980