Regional Animal Shelter

Please complete this application form if you are interested in becoming a Independence Animal Services volunteer. Once you complete the form, click the Continue button at the bottom.

Name and address

Please complete the following information

First name:

Last name:

Middle name:

Nickname:

Street 1:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers. Volunteers must be over 18 years old, or at least 16 with parental consent

Please enter a password that:

Is between 8 and 30 characters long
Contains both letters and numbers.
Contains a combination of both uppercase and lower case letters.

Password:

Confirm password:

Date of birth:

(year optional)

T-Shirt size:

Want to Foster:

Orientation

Below are the available date for Orientation. At the Orientation, we will explain what opportunities are available for you at the shelter. If you are over 16, but under 18 years old, a parent will need to accompany you to this orientation

Times

Assignment

Emergency Contact

Please enter the persons information that you would like us to contact in case of an emergency.

First name:

Last name:

Middle name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Relationship:

What organizations have you volunteered for?

What type of animal experience do you have?

What Pets Do you currently have at home?

Do you have any animal allergies?

What skills/talents that you would to use?

Are you interested in fostering animals?