Columbia-Greene Humane Society/SPCA

Volunteer Application

Please print this form and mail or fax it to us,

or bring it into the Shelter. Thanks!

Share your time and talents with others . . .

Become a Humane Society volunteer!

The Columbia-Greene Humane Society/SPCA is dedicated to the protection, humane treatment and well-being of all animals. We do not euthanize animals for space constraints and receive no federal, state or county funding. Because of this we rely heavily on donations which include donations of time generously given by our volunteers.

Date: _____/______/______

________________________________________________________________________

Last Name: First Name(s):

Are you 18 years of age or older?  Yes  No

(VOLUNTEERS UNDER 18 MUST BE ACCOMPANIED BY A PARENT AT ALL TIMES.)

If under 18, please list the name of the parent(s) who will accompany you:

________________________________________________________________________

Last Name: First Name(s):

Home Address: ___________________________________________________________

___________________________________________________________

(Please include number, street, city, state, and zip code)

Home Phone: (_____)_______-__________ Work Phone: (_____)_______-__________

Cell Phone: (_____)_______-__________ Email: ______________________________

Are you a student?  Yes  No  Full-time  Part-time

School: _________________________________________________________________

Is it necessary to limit your physical activity in any way?  Yes  No

If so, please explain: ______________________________________________________

_______________________________________________________________________

Are you a licensed driver?  Yes  No

Would you enjoy working with:  Dogs  Cats  Special Events/Functions

What hours are you available? (Shelter hours are only 11:30 a.m. to 4:00 p.m.)

Monday _______________ Tuesday _______________ Thursday _______________

Friday _________________ Saturday ______________

List previous experiences (volunteer, paid, or educational) that may be helpful in working with shelter animals:

Activity Organization Date(s)______

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Why do you want to volunteer at the Humane Society?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Please give the name of any person(s) who should be notified in the event of an emergency:

NAME ADDRESS PHONE # RELATIONSHIP

1) _____________________________________________________________________

2) _____________________________________________________________________

3) _____________________________________________________________________

I understand that the above information is voluntarily supplied and may be used and disclosed for Humane Society purposes, and that as a Humane Society volunteer I will not be paid for my services. If I am the parent or guardian of the applicant, I understand that it will be my full responsibility to remain in the presence and control of the applicant at ALL times while the applicant is on CGHS premises.

Applicant: _______________________________________ ______________________

Signature Date

Parent: _____________________________________________________________

Signature Date