First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

Text/Pager Email*

Please indicate your date of birth (month, day and year.)*

Which program are you interested in volunteering with? (Shelter, Randall's Place, Fundraising Event, Administration etc.)*

How many hours per week are you interested in volunteering and which days/times are you available?*

I understand that rescue animals are unpredictable in nature and behavior.*
Choose one: Yes No

I agree that any animal rescued by DSAR is solely owned and is property of DSAR. As a volunteer of this organization, I will not withhold, sell or give away any animal entrusted to me by the organization.*
Choose one: Yes No

I understand that during my volunteering I may have access to confidential, proprietary and/or trade secret information belonging to DSAR. I agree that I will keep all of this information strictly confidential and refrain from using it for my own purposes or from disclosing it to anyone outside DSAR.

In case of emergency, I authorize DSAR to notify the contact listed below. Please indicate the name, relationship, home phone, cell phone and work phone of your emergency contact.*

By filling in my name below, I certify that I understand and have answered truthfully all questions on this volunteer form and waiver and that I am 18 years or older. If this applicant is under age 18, by filling in my name below, I certify that I am the parent or legal guardian of this applicant and I have read and understand all questions and items on this form and approve this application.*