Springfield Humane Society, Inc.
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______________

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