Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate *

MM

DD

YYYY

Cell Phone *

(###)

###

####

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Are you under age 18? *

Yes

No

Cell Phone of Parent/Legal Guardian

(###)

###

####

Best number to call in case of an Emergency?

(###)

###

####

Name of First Emergency Contact *

First Name

Last Name

Cell Phone *

(###)

###

####

Alternate Phone Number

(###)

###

####

Name of Second Emergency Contact *

First Name

Last Name

Cell Phone *

(###)

###

####

Alternate Phone Number

(###)

###

####

Please describe the type and extent of your dog experience and skills. *

Owner

Therapy

Agility

Kennel Staff

Vet Work

Pet Sitter

Show

K9 Handler

Professional Trainer

Schutzhund

Herding

Search & Rescue

Protection

Attended Obedience Classes

Other

Do you currently have a dog? *

Yes

No

Have you had dogs in the past? *

Yes

No

Have you or do you currently volunteer with other organizations? *

Yes

No

Work Number

(###)

###

####

Why would you like to volunteer? *

Personal Fulfillment

For the dogs! I want to help them find their forever homes.

I want to get more involved in my community.

What would you like to help with? *

Showcase Events

Dog Evaluation

Fundraising

Promotional Events

Fostering

Adoption Counseling

Dog Handling

Marketing

Public Relations

Creative Services

Education & Awareness

Merchandise

Transport Dogs

Are you able to attend at least one event each month? *

Yes

No

Date Signed *

MM

DD

YYYY