Personal Information

Date of Birth *

First Name *

Last Name *

Address *

City *

State *

Zipcode *

Phone *

Email *

Driver's License # *

Emergency contact name *

Emergency contact number *

Are you volunteering to fulfill a court ordered community service program? *

Please explain. *

Do you have health insurance? *

Volunteer Interests

Please choose Yes for any of the categories you would like to volunteer for and No for the ones you are not interested in.

Dog Care (walking, cleaning, enrichment, etc.) *

Cat Care (cleaning, enrichment, adoption help, etc.) *

Being on a Committee (event planning, etc.) *

Tabling off-site events. *

Office/Computer (data entry, file organization, etc.) *

Helping Out at the Shelter - General Cleaning and Ground Maintenance *

Bathing and Grooming Animals *

Thrift Store - Merchandising, Cashiering, Stocking, Cleaning *

How many hours are you willing to commit to as a volunteer? *

Please use the table provided to enter your availability.

Please explain what you hope to contibute as a volunteer? *

Please explain what you hope to gain through you experience volunteering? *

Please list any relevant animal care/volunteer experience. *

Do you have a criminal conviction in the last 10 years? *

Please explain. *

Are you willing to undergo a background check? *

Please provide 2 references, please include name, relationship, phone number and email address *

Thank you for your interest in volunteering.

Signature *

Date *