Volunteer Application Form (Service Hours Only)

Please complete this application form if you are interested in becoming a Humane Society of Greater Dayton volunteer. Once you complete the form, click the submit button at the bottom.

***PLEASE NOTE, if you are required to serve 20 HOURS OR LESS, you WILL NOT be permitted to work hands-on with the animals.***

We are also UNABLE to accommodate service hours for the following charges:

-Violent Offenses

-Drug Related Offenses

-Animal Cruelty

-Sexual Offenses

Contact Information

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Primary Phone phone:

Email address:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Home phone:

* OK to call here

Cell phone:

OK to call here

Relationship:

General Information

Date of birth:

Age range:

Education Level:

T-Shirt Size:

Gender:

High School:

College:

Employer:

Please list any health related or physical limitations.

Skills & Interests

Please check all areas in which you feel you have moderate to excellent skill.

Experience

Please complete information about your recent work and/or volunteer experiences.

Please briefly describe any previous volunteer experience(s).

School Hours

School Service Hours Required?:

If yes, please provide the school's name and when you will need your hours COMPLETED.

Criminal History

Please note any past criminal activity. Noting criminal activity will not automatically disqualify you as a volunteer.

Please provide a case number/court charges or case manager information if applicable.

-DATES AND LOCATIONS REQUIRED-

Have you been convicted of a crime?:

Court Service Hours Required?:

If yes, please DESCRIBE conviction(s) including dates and locations.

Reason for Volunteering

Volunteer Orientation

Please select a date that best fits your schedule. Orientation will be held at the Humane Society and will last about 2 hours. Please note our maximum capacity is 5.

Times

Assignment

I Agree

I understand and agree that submitting this application form does not automatically register me as a Humane Society of Greater Dayton volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree