Volunteer Application

Personal Information
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Zip Code *
Cell Phone Number (Please enter as 000-000-0000) Please use the following format 248-555-1212
Home Phone Number (Please enter as 000-000-0000) Please use the following format 248-555-1212
Email Address * Please make sure to enter this correctly, as this is the main way we will contact you
Date of Birth *
Parent / Legal Guardian Name (If under 18 years of age)
Emergency Contact Name *
Emergency Contact Phone Number *
Employment Status *
If you are employed, please list employer name. If you chose "other" above, please explain:
How much experience do you have with cats and dogs? Please elaborate :) *
Do you have Health Insurance? *
What will you do if you are scratched, bitten or otherwise harmed by an animal? *
Have you ever been convicted of abuse or neglect of a child or animal? If yes, please explain: *
Why would you like to volunteer with us? (Community Service hours, love animals, want to help, etc.) *
Are you looking to volunteer short term (Just to fulfill required hours) or long term (as long as needed)? *
Are you volunteering to fulfill a court ordered community service program? If so, for whom? *
When are you available?
What days are you available? *	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
What Hours are you available? *	Morning (8-12am) Noon (11-2pm) Afternoons (2-5pm) Evenings (5-8pm)
How many hours would you like to help each week? *
Please list any limitations (heavy lifting, allergies, disabilities, etc.)
How would you like to help?
Please check which areas you'd like to help with	Cleaning cat areas Cleaning the store Helping with the bookstore Volunteering at fundraisers Grants Online work Other
Please carefully read the following policies, and signify your agreement to adhere to them by signing below.
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. As a Midwest Pet Refuge volunteer, I agree to release and hold harmless Midwest Pet Refuge from and against any and all loss, damage, claims, liability, costs, and expenses, of any nature whatsoever, including without limitation attorney’s fees and disbursements, arising from or occasioned by me and or my child’s participation in Midwest Pet Refuge programs. I understand that there are certain risks inherent in handling animals and I accept those risks. I understand that if an accident or injury should occur, I will notify a MPR representative and seek any necessary medical attention utilizing my own medical insurance. I agree to never harm or abuse the animals in the rescue in any manner.
Signature *

Check all entries for accuracy, then press the "Submit" button ONLY ONCE. If you do not receive a confirmation email after you hit Submit, please re-submit your application.

Volunteer Application

Personal Information

When are you available?

How would you like to help?

Please carefully read the following policies, and signify your agreement to adhere to them by signing below.