Date:
Name:
Home address:
Home phone:
Other phone (please specify):
Email:
Person to contact in case of emergency - name, relationship, phone:
Are you 18 or older?	Yes No
If younger than 18, how old are you?
How did you hear about our volunteer program?
Have you ever been convicted of a crime causing harm to people or animals?	Yes No
If yes to above, please explain:
Are you applying to volunteer to fulfill court-mandated community service hours?	Yes No
Do you have a condition (physical, developmental, emotional) that might limit your service or require extra assistance?	Yes No
If yes to above, please explain:
Can you read and comprehend information at a ninth grade level or above?	Yes No
Please list any other animal rescue groups you have been/are involved with:
Do you want to work at the shelter with dogs (regular 'routine')?	Yes No Maybe
Work at the shelter with cats (regular 'routine')?	Yes No Maybe
Play with, train, groom, socialize dogs as your schedule allows?	Yes No Maybe
Play with, train, groom, socialize cats as your schedule allows?	Yes No Maybe
Vet transports?	Yes No Maybe
Shopping for supplies?	Yes No Maybe
Help at special events?	Yes No Maybe
Help with admin/computer tasks?	Yes No Maybe
Are there specific days/times you are available to volunteer?
Why do you want to volunteer with us?
Anything else you'd like us to know?