First Name*
Last Name*
Address
City
State/Province
Zip/Postal Code -
Email*
Alt Email
Primary Phone Number:*
Alternate Phone Number:
Are you 18 years of age or older?* Choose one: Yes No
If not 18 years of age; how old are you? (For safety reasons, volunteers can start at 10 years of age for cat care and 14 years of age for dog care and must be supervised by a seasoned volunteer or parent/legal guardian until competent in cat/dog care. Those younger are encouraged to arrange dates/times to visit the shelter and interact with cats and appropriate dogs only with a parent/legal guardian's supervision).
What is your occupation?*
Have you, or any other member of your household, ever been arrested, charged or convicted of any animal-related crime such as failure to provide adequate care, animal cruelty, animal abandonment, animal neglect or any crime of moral turpitude?* Choose one: Yes No
Please choose which committees on which you would like to serve: (Check all that apply)
Please give us an idea of what days and/or hours you could reasonably be expected to volunteer? (While it is not required, volunteers that can commit to a set schedule are highly desireable. This allows us to make sure that the animals in our care have their needs met during each scheduled shift. Direct care shifts with the animals occur every morning and late afternoon/evening). *
List two references, including phone numbers, of people who are not family members. If volunteering to meet a community service obligation, contact information must also be provided for probation officer or other contact within the legal system. *
By selecting "YES" below, Volunteers of Safe Haven of Iowa County do hereby release, discharge and hold harmless Safe Haven of Iowa County and any persons, firm or corportation charged or chargeable with liability together with their heirs, administrators, executors, successors and assigns from any and all claims, damages, costs, expenses, loss of services, actions or causes of action or occurance arising out of or in connection with the direct care of a pet for Safe Haven of Iowa County.* Choose one: Yes No
