Since 1941
Volunteer Information
Please PRINT clearly
Name________________________________________
Date______________________
Address_____________________________________City________________________
Physical address if different from above_______________________________________
Phone: Home_________________ Work___________________ Cell_______________
e-mail_________________________________ Date of birth_______________________
Emergency contact name & number___________________________________________
List any special skills, training, hobbies
______________________________________________________________________
______________________________________________________________________
Please check the volunteer opportunities in which you would be interested:
___ cat grooming/socializing ___
special events ___ other ideas _________________
___ dog walking___
marketing/PR ___ gardening/yard
work ___ fund raising
___ Mr./Ms. Fix-It Jobs ___ foster home
Please indicate days and times you are available:
Wed:________ Thurs:________ Fri:________ Sat:________
For Dog Walking Only:
Monday and Tuesday we are not open however, if you are volunteering to be
a dog walker and can be here
between 9 A.M. and noontime when we are here
cleaning and feeding the gang, we would love to have you
come in.
Monday ________ Tuesday ________
Are you currently enrolled in school? Yes No If yes, what school?__________________
Previous volunteer experience ___________________________________________
___________________________________________________________________
Do you have any experience working
with animals?
Describe____________________________________________________________
___________________________________________________________________
Do you have pets? Yes No Are they spayed or neutered? Yes No
Are you currently employed? Yes
No
If yes, may we contact you at work? Yes No
Employer_____________________________ Brief description of what you do at work
___________________________________________________________________
Please list two references that are not family members:
___________________________________________________________________
Name Relationship Phone
___________________________________________________________________
Name Relationship Phone
My signature gives permission to
the Springfield Humane Society to verify all information given herein.
Signed________________________________________________Date______________
Revised12’10