OO.. ..OO..  The Humane Society Of Elmore County   255 Central Plank Road (Hwy 9)  Wetumpka, Alabama 36092

              E-mail: hselco@bellsouth.net      PHONE: (334) 567-3377      FAX: (334) 567-8774

 

 

Online Volunteer Request Form

Name: Date:
(Last) (First) (MI)
Address:
(Street) (City) (State) (Zip)
Phone: (Home)  (Cell) (Work)
Email: Date of Birth:(MM/DD/YYYY)

                                                             Under 18 requires signed parental permission. Please visit shelter for form.


Emergency Contact Person: Relationship:
Phone: (Home) (Cell)  (Work)

 

 

Please check activities you wish to assist the shelter:

Visit and play with animals

Assist with PetSmart Adoptions (Generally Saturdays)

Bath and grooming of animals

Office help (answer phones, filing, and greeting)

Nursing Home Visitation Program

Help with animal rescue, housing, care, natural disasters

Building Repair

Electrical

Plumbing

Painting

HVAC

Auto Repair/Maintenance

Assist at the Tail's End Thrift Store

Assist with off-site supply drives

 

 

Animal Foster Care: (Please check those pets you can assist)
Dogs

Cats

Puppies

Kittens

Dogs w/litters

Cats w/litters

Birds

Guinea Pigs

Pocket Pets

Reptiles

Horses

Goats

Pigs

Farm Animals

 



Please select day(s) you can assist:
Mon 
Tue        
Wed
Thu   
Fri    
Sat   

 


Do you own animals? Yes No

If so, how many and what kind?


Are your animals up to date on their vaccinations? Yes No Are they spayed/neutered? Yes No


Who is your veterinarian?


Do you have a truck or stock/horse trailer to help with animal or supply transport? Yes No
If yes, please describe the vehicle/trailer or how you could help:



Do you have experience in computers, publishing, grant-writing, fund raising? Yes No
If yes, please describe:


Please tell us anything else about yourself (student, retired, memberships, special animal experience or training, etc) that
you think would be good for us to know:


Have you ever been charged with or convicted of a crime (not including traffic tickets) to include any charges
or convictions of animal cruelty or neglect?
Yes No If Yes, please explain:


All information supplied on this form is accurate and I am willing to sign a Liability Waiver which will be
maintained on file with this application at the Shelter.


_____________________________________________________  _________________
Volunteer Signature                                                               Date

By filling out the above form and clicking submit, I am agreeing to the terms and conditions of the Humane Society of Elmore County. Individuals under the age of 18 will have to appear with a responsible adult or parent at the Humane Society Office and provide written authorization for a minor to volunteer.
 

E-mail: hselco@bellsouth.net      PHONE: (334) 567-3377      FAX: (334) 567-8774

The Humane Society Of Elmore County   255 Central Plank Road (Hwy 9)  Wetumpka, Alabama 36092