First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Your Employer:*

Partner's Employer

Partner's Employer:

Please list all current pets living in your household including name, type, breed, gender, age and weight for all dogs.*

Are all of the animals in your home spayed and neutered?

If your animals are not spayed or neutered, please explain why not.

Please provide the name of your vet practice with full address and phone number (including area code) for your current and previous pets (if more than one vet practice has been used, please list all).*

Please provide your vet's phone number. Please advise them we will call to verify vetting information.

Personal (non-family) Reference #1: Name and Email Address*

Personal (non-family) Reference #2: Name and Email Address*

How did you hear about LPDR?

How many hours a week are you available to volunteer? *

Areas of Volunteer Interest (please check as many as apply):

Do you have any special skills you’d like to share with us?

If yes, how long ago?

Please briefly describe any volunteer work you have done in the past

Do you currently have any of the following social media accounts?

I attest that I understand the risks present in volunteer duties, particularly in working with animals, and freely assume those risks and agree to release and indemnify Little Paws Dachshund Rescue, its officers, agents, employees and volunteers from and against all claims for injury, accident, loss or danger to the undersigned as a result of such volunteer duties.