Name:	__________________________________________Date:__________
Address:	__________________________________________________________
	__________________________________________________________
Phone:	Home:_____________Work:______________E-mail:______________

Age Group (check one): _____13-17       _____18-35       _____36-60       _____60-over

Consent for minor: I (parent/guardian) ____________________ give my consent for (minor) ____________________ to volunteer at the Humane Society. Some jobs required being 18 or older.

I would like to volunteer for (please check all that apply): _____Cats      _____Dogs      _____Both

_____ Receptionist _____ Pet area clean-up _____ Bingo _____ Medical _____ Socialization _____ Photograph _____ Special events _____ Foster care _____ Fund-raisers _____ Transporting dogs _____ Walking dogs _____ Community booths _____ Landscaping _____ Maintenance _____ Laundry _____ Picking up supplies _____ Phone calling _____ Comfort care

I am available on the following days:

_____ Monday _____ Tuesday _____ Wednesday _____ Thursday _____ Friday _____ Saturday _____ Sunday

I am available these hours:

_____ Morning _____ Afternoon _____ Evening

Comments or Special Skills:

If you have any questions, about volunteering, please call (740) 392-2287.