1. sports
2. dog sled

ALASKA SONGBIRD INSTITUTE
P.O. Box 80235

Fairbanks, AK 99708

www.aksongbird.org
ASI YOUTH MENTORING PROGRAM APPLICATION PACKET 2015
About the Alaska Songbird Institute (ASI): ASI is a nonprofit organization in Fairbanks, AK whose
mission is to conserve Alaska’s boreal birds through ecological education & research. ASI has two projects
on Creamer’s Refuge: the Swallow Ecology Project and the Creamer’s Field Migration Station. Please visit
www.alaskabird.org for more information.
Program Description: Students will assist Alaska Songbird Institute Program Director, Tricia Blake, with
ASI’s Swallow Ecology Project. Field sites include Creamer’s Field and the University of Alaska, Fairbanks
campus. Students will assist with:
•
Monitoring the nest boxes at: Creamer’s Field and the UAF campus (T-field, potato field, and
agricultural farm)
•
Recording lay, hatch, & fledge dates for each active nest
•
Capturing and banding adult birds
•
Recording data
Qualifications: Applicants should:
•
be 10-14 years old
•
possess a sincere interest in birds, science, and conservation; a positive attitude; and a genuine desire
to learn more about birds and scientific research
•
be in good physical condition and able to walk or bike to all of the nesting boxes at Creamer’s Field
and UAF; students are generally out for 2-3 hours at a time.
Hours: The project runs from approximately May 18-July 17. Students are asked to volunteer at least 4
hours/week, and are invited to volunteer as much as they would like. We will use an online calendar for
scheduling. It is okay to miss time for vacations, traveling, and camps! The schedule is very flexible.
Program Fee: There is a $200 program fee per student. This fee helps to cover the cost of insurance,
permitting, supplies, personnel, and other costs associated with running the project.
To Register: Please submit the registration form and the $200 fee to Alaska Songbird Institute, P.O. Box
80235, Fairbanks, AK 99708. Checks should be made payable to the Alaska Songbird Institute. Forms may
also be submitted electronically to: [email protected]. Priority will be give to applications
received by May 1.
Thank you for your interest in the Alaska Songbird Institute! Please don’t hesitate to contact us with
questions. We will hold an informational meeting for kids and parents in early May. Stay tuned for details!
©2015
ALASKA SONGBIRD INSTITUTE
P.O. Box 80235

Fairbanks, AK 99708

www.aksongbird.org
YOUTH MENTORING APPLICATION 2015 PERSONAL INFORMATION Name & Age:
Parent(s)/Guardian(s):
Date of birth:
Grade:
School:
Phone:
Email:
Current address:
City/State/Zip:
INTERESTS & SKILLS (USE THE BACK OR ADDITIONAL PAGES IF NECESSARY) What do you like to do? Tell us about your hobbies, favorite activities, and any volunteer experience you have.
Why are you interested in helping to study swallows?
What are your strengths? How do you think you could help us with our project studying birds in Fairbanks?
SIGNATURES Signature of
Student:
Date:
Signature of
Parent/Guardian:
Date:
Return by May 1 to: Alaska Songbird Institute, P.O. Box 80235, Fairbanks, AK 99708 or by email: [email protected].
©2015
ALASKA SONGBIRD INSTITUTE
P.O. Box 80235

Fairbanks, AK 99708

www.aksongbird.org
Alaska Songbird Institute Waiver of Liability
Child’s Name: ____________________________________________ Date: ____________
will be volunteering with the Alaska Songbird Institute. I understand that while working in the field
he/she may encounter a variety of risks. Inherent dangers for this work are likely to include but are
not limited to: difficult footing; exposure to hot, cold, and/or wet weather; possible exposure to
moose, bears, and other wildlife; exposure to sun, insects, and other environmental hazards;
possibility of being scratched or pecked by a bird.
I am aware of the inherent dangers involved and I freely and knowingly assume all risks to my
son/daughter and his/her property. I will ensure my child is prepared for work in the field each day
with appropriate clothing, footwear, sunscreen, insect repellent, and other necessary supplies.
Name of Parent/Guardian (print)________________________________________________
Address____________________________________________________________________
City_______________________________________State_____________Zip____________
Phone (_____)_________________________________
Signature______________________________________Date______________________
Alaska Songbird Institute Photo Release
I hereby give permission for the Alaska Songbird Institute to use my child’s portrait, photograph,
artwork or images to promote the organization, its programs, and achievements. Such use includes
but is not limited to using images in public presentations, publications (print or electronic), grant
applications, brochures, displays, reports, and on web pages and social media.
Signature______________________________________Date______________________
©2015
ALASKA SONGBIRD INSTITUTE
P.O. Box 80235

Fairbanks, AK 99708

www.aksongbird.org
Volunteer Health & Emergency Contact Form
Student Name ________________________________________________________________
Address _____________________________________________________________________
Parent/Guardian Name _________________________________________________________
Home phone ______________Work phone _________________Cell Phone_______________
Emergency Contact (to be contacted if a parent or guardian cannot be reached):
Name ______________________________ Relationship to Student _____________________
Home phone _____________Work phone __________________ Cell Phone______________
Address _____________________________________________________________________
Physician Name:_______________________________________Phone:__________________
Allergic Reaction to: Penicillin ______________
Bee Stings ________________
Food ________________________________________________________________________
Other allergies_________________________________________________________________
Is your child currently taking any medication? (name and explain)________________________
_____________________________________________________________________________
Does your child require any special (emergency) medication? (name and explain)____________
_____________________________________________________________________________
If your child has any special physical or social problems that require special attention or
considerations that are not covered on this form, please explain:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
**Medications such as aspirin and TYLENOL can not be given out by Alaska Songbird Institute
staff. If you feel your child may need such items, please send them with them.
___________________________________
Parent/Guardian Signature
________________________
Date
©2015