HUMANE SOCIETY OF SCHOOLCRAFT COUNTY VOLUNTEER APPLICATION

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HUMANE SOCIETY OF SCHOOLCRAFT COUNTY

PO Box 44, Manistique, Michigan 49854
VOLUNTEER APPLICATION

Personal Information

Date:__________________________

Name:__________________________________ Age (circle) under 18 - over 18

Present Address:__________________________________________________________________

Home Phone:_____________________________ Work Phone:___________________________

1) Please describe your reasons for wanting to volunteer at this animal shelter:_______________________

__________________________________________________________________________________

2) List any previous experience working with animals:_________________________________________

__________________________________________________________________________________

3) List any other experiences, paid or volunteer, that you think are relevant to volunteering at the HSSC.

__________________________________________________________________________________

4) Please list any mental or physical (including allergies) limitations that could affect your volunteer work here.

__________________________________________________________________________________

5) All volunteers are required to have their own health insurance. Please indicate your insurance company and policy number here, and show proof of your insurance (such as insurance card).

Name of Insurance:

Card or Policy Number:

If at any time while you are working here, your insurance coverage should lapse, you must inform the shelter manager of the situation. I understand that the H.S.S.C. does not have health insurance coverage for its volunteers.

(sign)_____________________________________________________________________________

6) Are you pregnant at this time, or are trying to become pregnant?_______________________________

7) How did you hear about our volunteer program?___________________________________________

_________________________________________________________________________________

8) References: Please give the name of two people who have known you for at least two years, (not related

to you) that we may contact.

#1 Name:_________________________________	Phone:__________________________________
Years Known_____________________________	Relationship:______________________________
#2 Name:_________________________________	Phone:___________________________________
Years Known_____________________________	Relationship:_______________________________

AREAS OF INTEREST (choose as many as apply)

animal care/cleaning	____	yard or building maintenance	____
dog walker	____	foster home	____
dog trainer/manners	____	office worker	____
cat care	____	fundraising activities	____
kitty cuddler	____	public speaking on animal care	____
animal transport	____	other (specify)	____

For explanations of above you may call 341-1000

AVAILABILITY

Monday - a.m.__________ p.m.__________	Friday - a.m.__________ p.m.__________
Tuesday - a.m.__________ p.m.__________	Saturday - a.m.__________ p.m.__________
Wednesday - a.m.__________ p.m.__________	Sunday - a.m.__________ p.m.__________
Thursday - a.m.__________ p.m.__________

Number of hours willing to work per week________ or month___________

Anticipated length of commitment: (circle) 1-3 months 4-6 months 6-12 months

IN CASE OF EMERGENCY CONTACT:

Name:________________________________________	Phone:______________________________
Address:______________________________________	Relationship:_________________________

Physician's name:________________________________	Phone:______________________________
Insurance Co.___________________________________	Policy#_____________________________

Thank you for Volunteering!

Volunteers make things possible!