| PART
ONE: Tell us about yourself (please print legibly): |
LAST Name:
_______________________ FIRST name ______________________ Address:____________________________
__________________________________
City: ___________________ State: ________________ Zip:__________
Home Phone: _______________________________ Work Phone:___________________
Email Address: _____________________________ Date of birth:___________
Can you drive?
Yes
No
Are you a high school student?
Yes
No When will you graduate?______________
Are you a college student?
Yes
When will you graduate?______________
Do you have limited mobility, or any other limitations we should be aware
of?
Yes
No
If yes, please explain: ________________________________________________ |
|
Please do not call me for any activities outside of
the shelter,
as in fundraisers, etc. (*You must fill out Part Six)
I want to help wherever I am most needed
|
| |
| PART
THREE: Please check if you are interested in these other areas of
the Humane Association. |
Board of Directors Member
Education Committee Member
Fundraising Committee Member |
| PART
FIVE: Do you have any special talents, interests or suggestions
that you feel may be helpful to ECCHA? |
(Examples: Computer Programming, Crafting,
Pet Grooming, Gardening, Snow-Plowing, Carpentry/Maintenance, etc.)
Please explain:____________________________________________________ _______________________________________________________________ |
| PART
SIX: Shelter Volunteer Information: |
NOTE: You only need to complete this information
if you want to do volunteer work AT the shelter.
In case of emergency, please provide the information listed below (please
print legibly):
Emergency Contact Person:____________________________________
Relationship:______________________________________________
Contact Person’s Phone Number:________________________________
Date of Last Tetanus:_____________________ |