Are you 18 or older? **Required Field Yes No

Your Name: Today's Date: (mm/dd/yy)

Street Address:

City: State: Zip Code:

Email Address:

Home Phone: Other Phone (Optional):

Birthdate: (Month) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec (Day) 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year:(YYYY)

Where do you work / go to school?

Please list any hobbies / extracurricular activities:

Please list any special skills that you feel would be valuable to CHHS:

Why have you choses CHHS as a volunteer opportunity:

Describe the best experience you've had with animals?

Describe a bad esxperience you've had working with animals?

When are you available? (check all boxes that suit your schedule)

Monday
Morning 12 - 2 PM 3 - 3:45 PM

Tuesday
Morning 12 - 2 PM 3 - 3:45 PM

Wednesday
Morning 12 - 2 PM 3 - 3:45 PM

Thursday
Morning 12 - 2 PM 3 - 3:45 PM

Friday
Morning 12 - 2 PM 3 - 3:45 PM

Saturday
Morning 12 - 2 PM 3 - 3:45 PM

References: (Employer, Minister, School Gidance Counselor, etc...)

I am 18 years of age or older and I give permission for CHHS to contact the references provided.
**This is a Required Field

Name: Phone:

Relationship:

Name: Phone:

Relationship:

Name: Phone:

Relationship:

Emergency Information

In case of emergency, notify:

Name: Phone:

Relationship:

Who is your Physician?
(We will not contact your physician except in the event of an emergency)

Physician Name: Phone:

Before volunteering at CHHS, you will be required to sign a waiver of liability. The waiver will be signed at CHHS before you start volunteering. Click here to read the waiver.