| Date___________________________________ Are you
under 18 years old?
yes no Name__________________________________
If yes, date of birth____________________ Address________________________________
Home phone_________________________ _______________________________________
Work phone _________________________ Email__________________________________
May we call you at work? ______________
In case of emergency, please notify:
Name__________________________________ Home phone_________________________
Address________________________________ Work phone _________________________
_______________________________________ Relationship to you ___________________
Experience or skills you would be willing to share_________________________________________
_________________________________________________________________________________
Are you a member of the Frederick County Humane Society?
yes
no
When are you available to work?
days
evenings
weekends Please specify:
_________________________________________________________________________________
Do you have any physical or mental
disability that might make it difficult to perform certain volunteer duties
such as an inability to lift, etc.? Please explain. _________________________________________________________________________________
I am interested in the following volunteer positions (see
details on reverse)
Office / Clerical |
Fundraising |
|
Humane education |
Outreach |
|
Special Events |
Other ________________________________________ |
If you have any questions call 301-694-8300. Please
sign on reverse. |