First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email

Please provide the names and telephone numbers of 2 references who are not family members.*

Please describe your current pets, including name, breed, sex, and age*

Are they spayed or neutered?*
Choose one: Yes No

Have your pets been on heart worm preventative for the last 6 months?*
Choose one: Yes No

Please provide the name, address, phone, and e-mail (if applicable) of at least one veterinarian reference that is familiar with you and your family and the vet that currently provides the vet care for your own animals: *

Do you have experience with Rescue, (This IS NOT a requirement): If so, can you tell us about it?

Can you volunteer for any of the following:

Be a telephone contact for your local shelters and pounds?*
Choose one: Yes No Maybe

Identify an animal in shelter or pound? *
Choose one: Yes No Maybe

Be a telephone contact to assist owners in care and training, or referrals to those who can assist?*
Choose one: Yes No Maybe

Help with transporting Rescues from shelters to foster care, or Veterinarian? *
Choose one: Yes No Maybe

If yes, what days and how far are you willing to drive?

Be a contact for prospective adopting families?*
Choose one: Yes No Maybe

Help with screening new potential adopters?*
Choose one: Yes No Maybe

Perform a Home Visit?*
Choose one: Yes No Maybe

Help with the distribution of materials to your local shelters and other Rescue Groups, to aid in identifying Great Pyrenees? *
Choose one: Yes No Maybe

Provide possible contacts for reduced costs with your Veterinarian?*
Choose one: Yes No Maybe

Can you help with planning events?*
Choose one: Yes No Maybe

Can you help with fundraising?
Choose one: Yes No Maybe

Can you help with any of the following

What other tasks/duties could you help with?

Do you have any comments or questions?