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Volunteer Application
Have a special talent or interest? We need all sorts of volunteers. Let us know how you'd like to help.
Address
Who is your current veterinarian:
Current Vet's Address
Current Vet's Telephone (include area code)
Years with Current Vet
Past Veterinarian: (If with Current Vet for less than 2 yrs)
Past Vet's Address
Past Vet's Telephone (include area code)
Please provide 3 personal references (not related to you):
About Your Other Pets:
Do you own any other dogs? -- Please choose one -- Yes No
Are they spayed or neutered? -- Please choose one -- Yes No No animals at this time. If not, why?
Any other pets/livestock? -- Please choose one -- Yes No
List names, breed, age and sex of each of your current pets (cats, dogs, etc.): Pet #1 Pet #2 Last Vet Exam (s)
How many dogs have you owned in the last 5 years? -- Please choose one -- None One Two Three Four Five or more
What happened to your last dog? -- Please choose one -- Still Own Lost Stolen Given Away Died Other Please explain circumstances for above and please provide specifics, including name of dog, breed, and any other pertinent specifics: If your last dog was given away, please indicate the name and address of the person to whom the dog now belongs:
Are all of your animals (dogs and cats) current on vaccinations? -- Please choose one -- No animals at this time. Yes No No - Use Titer blood tests (explain below) No - Medical exclusion (describe below) If not, please explain.
Are all of your animals (dogs and cats) on heartworm preventative? -- Please choose one -- Yes No What type? (please specify)
Please describe your skills and tell us how much time you have available to volunteer:
Please submit your application by clicking once on the "submit" button at the bottom of this page.
Thank You!
Count Since Nov 2004
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