Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone Number

(###)

###

####

Cell Phone Number

(###)

###

####

Work Phone Number

(###)

###

####

Are You Over 21? *

Yes

No

Please select the options that best describe the type and extent of your dog experience and skills: *

Control-click (Windows) or command-click (Mac) to select more than one.

Owner

Kennel staff

K9 Handler

Pet Sitter

SAR

Protection

Attended Obendience Class

Herding

Vet Work

Therapy

Breeder

Schutzhund

Show

Professional Trainer

Agility

Other

Do you currently have a dog? *

Yes

No

Have you been a member of other volunteer organizations? *

Yes

No

What types of things would you like to do in Rescue? *

Control-click (Windows) or command-click (Mac) to select more than one.

Events

Fundraising

Photography

Telephone Hotline

Transport

Website

Writing (Newsletter)

Other

Have you ever been charged with cruelty toward animals? *

Yes

No