La Porte County Small Animal Shelter Volunteer Application

Today's Date *

Your first name *

Your last name *

Your date of birth *

Parent or Guardian's Name (If applicant is under 18 years old)

Your street address *

City *

State *

Zip code *

Home or Cell Phone *

Additional Home or Cell Phone

E-mail Address *

Do you currently live with any pets? *

If so, please tell us a little about your pets. Pet #1 Name:

Pet #1 Species

Cat
Dog
Other

Pet #1 Info

Current Pet #2 Name:

Pet #2 Species

Cat
Dog
Other

Pet #2 Info

Pet #3 Name

Pet #3 Species

Cat
Dog
Other

Pet #3 Info

Pet #4 Name

Pet #4 Species

Cat
Dog
Other

Pet #4 Info

Are you a student? *

If you are a student, please list your current grade or college year.

Current employer:

Which days of the week are you most likely to volunteer? *

What time of day are you most likely to volunteer? *

Morning
Afternoon

Do you prefer working with: *

Dogs
Cats
Both Dogs and Cats

Do you have any allergies? *

Yes
No

What kind of work would you like to do here?

Please choose all of the following that you are willing or able to do: *

Is there anything else you would like to tell us about yourself?

VOLUNTEER WAIVER OF LIABILITY ** I am aware that during volunteer service at the La Porte County Small Animal Shelter, I could be injured or bitten by an animal or have an allergic reaction to some of the solutions which are used to disinfect the animal areas. I hereby release the La Porte County Animal Shelter from any and all liability connected with my duties as a volunteer. *

Yes
No