Personal information Date of Application_____
Name ______________________Address_________________________________
Day phone________________Night phone_______________Cell______________
Age DOB____________
Volunteers under the age of fifteen must be supervised by an adult.
If you are a student, what year are you in?_________

Please provide two personal references:
Name__________________Relation__________________Phone_________________
Name__________________Relation__________________Phone_________________
In case of emergency
Contact________________ Relation__________________Phone_________________
2nd contact______________Relation__________________Phone_________________

Please indicate the reason why you are seeking a volunteer position, chek all that apply:
____Personel fulfillment
____Extra time
____Required for school
____Court Mandated Community Service
Reason for court mandated hours___________________________________________
Have you ever been convicted of a criminal offense?
If yes, explain__________________________________________________________

Do you have any concerns regarding euthanasia?_Yes or No
If yes, please specify:____________________________________________________
Do you have any medical problems that we should be aware of?____________________
Do you have any experience working with animals?______________________________