La Porte County Small Animal Shelter Volunteer Application

Today's Date

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Your first name

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Your last name

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Your date of birth

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

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Your street address

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City

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State

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Zip code

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Home or Cell Phone

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Additional Home or Cell Phone

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E-mail Address

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Do you currently live with any pets?

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

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Pet #1 Species

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Cat
Dog
Other

Pet #1 Info

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Current Pet #2 Name:

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Pet #2 Species

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Cat
Dog
Other

Pet #2 Info

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Pet #3 Name

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Pet #3 Species

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Cat
Dog
Other

Pet #3 Info

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Pet #4 Name

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Pet #4 Species

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Cat
Dog
Other

Pet #4 Info

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Are you a student?

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

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Current employer:

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

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What time of day are you most likely to volunteer?

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Morning
Afternoon

Do you prefer working with:

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Dogs
Cats
Both Dogs and Cats

Do you have any allergies?

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Yes
No

What kind of work would you like to do here?

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

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

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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.

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Yes
No