Volunteer Application

EMPORIA ANIMAL SHELTER
VOLUNTEER APPLICATION
Full Name ___________________________________________________
Date of Birth ___/___/____ Are you over 18? Yes ( ) No ( )
Address _____________________________________________________________
City __________________ State ______________ Zip _____________
Primary Phone # _________________________ Cell Phone ______________________
Email _______________________________________________________________
Emergency Contact ___________________________________
Relationship ________________________________________
Emergency Contact Phone # _____________________________
Have you ever been arrested or charged with child abuse or animal abuse? Yes ( )  No ( )
Have you ever volunteered with us before? Yes ( ) No ( ) If yes, what type of tasks are you familiar with?
Why do you want to volunteer at the Emporia Animal Shelter?
Are you interested in volunteering for special events? (i.e. Parades, adoption events, fund raising, etc.)
Yes ( )  No ( )
Can you commit to certain days of the week and/or certain hours? Yes ( )  No ( )  If yes, which days and hours ?
Which areas are you interested in volunteering for? Check any that apply.
( )  Dogs-assist in kennels
( )  Cats-assist in cages
( )  Socialize Cats
( )  Socialize Dogs
( )  Housekeeping
( )  Assist with Adoption Events
I GIVE THE SHELTER AND THE HUMANE SOCIETY OF THE FLINT HILLS PERMISSION TO VERIFY ANY OF THE ABOVE INFORMATION. I UNDERSTAND THAT THIS APPLICATION DOES NOT GUARANTEE ACCEPTANCE TO THE EMPORIA ANIMAL SHELTER VOLUNTEER PROGRAM.
Signature _______________________________  Date ___/___/____
Signature _______________________________ Date ___/___/____
(Parent or Guardian)