School/Church Community Service Questionnaire

By submitting this form I certify that the statements I have made on this application are true and I understand that management has the right to terminate my option to serve community service hours at their facility at any time for any reason at their discretion.

Center>--------FOR SJRAS USE---------

Interest Session Date
Orientation Date
Orientation By
Signed Waiver

Cat Handling Date
Dog Handling Date

Signed Handbook
Email Entry Date