Hope Rescues Volunteer Application 3 701 Coronado Dr lton, IL 62002 ell 1: 618-979-1908 2 : (636) 212-0363
Date (mm/dd/yyyy) :
Volunteer Interest:
Foster Home
Big Brother/Big Sister
Fundraising
Daily Care
While holding your Ctrl button
Daily Care Consists of Walking, Feeding, Socializing and Cleaning of the Dog
If you are volunteering for Daily Care, what days would
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
While holding your
Personal Information
Applicant's Name:
Age:
Driver License Number :
Present Street Address:
City: State: Zip:
How long at this address?
Home Phone Number:
Cell Phone Number:
Work Phone Number:
E-mail Address:
Are you over 19 years of Age ?
Yes
No
Occupation:
Your Current Home Environment
Own
Rent
Pick One
House
Duplex
Apartment
Condo
Mobile Home
Other
Do You Rent or Own ?
Type of Home you currently live in:
The following questions only apply if you do not own your own home:
Name of apartment complex, mobile home park or landlord (if applicable) :
Yes
No
Please list pet restrictions, if any (i.e., weight, number of pets allowed, etc.
Yes
No
Do you have a fenced yard ?
The following questions only apply if you have a fence
Pick one
Wood
Chain Link
Vinyl
Other
Ft.
Members Within Your Household
How many Adults live in your home ?
How many children live in your home ?
List Ages:
Yes
No
Do any members of your household have allergies ?
Information of Current Pets:
Please list all of the pets currently in your
Yes
No
Are any of these pets kept outdoors ?
Yes
No
Are all of your pets spayed or neutered ?
If you answered "No", which pets are not spayed / neutered ?
Veterinarian Information:
Veterinarian's Name:
Vet's Address:
Vet's Phone Number:
Pet History:
Have you had any other pets in the last five years that are
Yes
No
If yes, list the Type of Animal, Sex, Age, Spayed /
Yes
No
Have you adopted any pets from a rescue group or animal shelter in the past?
If yes:
Where is this pet now?
Fosters - Pet Specifics:
Male
Female
No Preference
Gender of the dogs are you interested in working with ?
Is there a specific age ?
Pick One
Adult (over 1 yr. to 3 yrs)
Adult (over 3 yrs )
Older Puppy (5 mos. to 1 yr.)
Puppy (Younger than 5 mos.)
No preference
Pick One
Toy (Under 10 lbs)
Small ( 11-25 lbs)
Medium (26-50 lbs)
Large (51-90 lbs)
Giant (Over 90 lbs)
No preference
What size of dog are you interested in ?
Pick One
Very Active (needs lots of exercise)
Active (needs a moderate amount of exercise)
Sedentary (couch potatoe)
No preference
How active would you like your pet to be?
My pet will be kept:
Pick One
Mostly indoors
Mostly outdoors
Equally indoor / outdoor
Undecided
If your pet is left outdoors, what type of shelter will be provided?
Will you be using a tie-out or chain to secure the dog?
When your pet is left by itself, the pet will stay:
Pick One
Outside
Indoors in a crate
In a restricted area indoors
Allowed to roam free indoors
Where will your pet sleep at night?
How long will your pet be left by itself during the daytime?
If you live on acreage in the country, how will you
Medical Information:
In case of emergency, I authorize Hope Rescues to notify the contacts listed below.
1st Contact Name:
Phone Number:
Relationship to You:
2nd Contact Name:
Phone Number:
Relationship to You:
Please enter your initials in the space provided after each statement
1. To notify the Rescue Program if the pet is lost or stolen and to
2. To treat this pet as a family pet with affection and kindness,
3. To always keep this pet within a fenced yard - not on a chain, or
4. To never transport this pet unconfined in an open vehicle such
5. To notify the Rescue Program of a change in my address:
6. To allow the Rescue Program to periodically check on this pet.
7. To contact the Rescue Program, if problems arise so that the
8. I understand that I have no claim of ownership on this dog, and
9. To administer any medications designated by Hope Rescues
10. To notify Hope Rescues if the dog needs veterinary care.
I/we further understand and agree that:
RELEASE OF LIABILITY:
By your signature below, you hereby certify that the information given above is truthful and correct and that
Your Name
Date:
