Volunteer Application Application – Volunteer About You What type of volunteer position are you interested in? * Dog Room: Cleaning Assistant Dog Room: Dog Walker Cat Room: Cleaning Assistant Cat Room: Socialize / Enrichment Kitchen Area: washing dishes, laundry, Etc. Becoming a member of the Board of Directors Fundraising (participate in working fundraisers) Grant Writer (researching and writing grants that could benefit SWCHS) Other skills that I could offerOther skills that I could offer Check all that apply. Name * Name First First Middle Middle Last Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Address Primary Phone Number * Secondary Phone Number Email Address * I would like to receive emails from SWCHS No Yes Former Name(s) * Maiden name, previous name before a name change, etc. Age * Must be 18+ to volunteer for dog interactions, 16+ for cat interactions due to insurance regulations Parent'(s’) First and Last Name(s) For any applicant under 18 years of age. Parent'(s’) Phone Number(s) For any applicant under 18 years of age. Emergency Contact Person, other than yourself, who we may contact if necessary. Name * Name First First Last Last Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Address Phone * Email Other Is your volunteer opportunity coordinated with a second organization? No Yes If yes: type the name of the organization If yes: type the first and last name of the contact person at the organization If yes: type the email of the contact person If yes: type the phone number of the contact person Have you ever been convicted of a felony or any animal related violations? No Yes Please explain: Visual Code Do you have any health issues or restrictions that SWCHS should be aware of while you are volunteering? No Yes Please explain: Visual Code Are you current on your Tetanus Vaccination? No Yes Proof will be required. Date Captcha If you are human, leave this field blank. In consideration of my participation in activities of the South Wood County Humane Society (SWCHS), I do agree to hold free from any and all liability the SWCHS and its officers, employees and members. I do release and forever discharge any rights and claims for damages or injuries, which I may hereafter incur, arising out of or connected with my participation in any activities or duties of the SWCHS. By submitting my application, I declare myself to be physically sound and medically able to participate in the activities of SWCHS.
