VOLUNTEER WORKER APPLICATION

Date:___________________

Name: _________________________________________________________

Spouse/Partner:__________________________________________________

Address: _______________________________________________________

City: ____________________ State: __________ Zip: __________________

E-mail address: __________________________________________________

Home Phone: __________________ Work Phone: _______________________

I Work :  YES ____        NO ____   Position:____________________________                      

Attend  School: YES____ NO____       Name of School:__________________

Employer or School: ______________________________________________

Other : __________________________________________________________

Spouse/Partner Works: YES___         NO___  Position:____________________

Employer or School:________________________________________________

Other:___________________________________________________________

HOUSING:   Own ____   Rent____    House____   Apt.____  Condo House____

Do you have a fenced yard available?                                    YES ____   NO ____

Have you participated in Keeshond rescue before?               YES____   NO ____

What experience do you have in rescuing animals? __________________________

___________________________________________________________________

Have you worked with any rescue groups in the past?          YES ____  NO ____

What groups?___________________________________________________

Please explain the reasons you are interested in helping with rescue. ___________

__________________________________________________________________

Indicate the ways you would be able to participate:


 

Visiting shelters to check dogs

Bailing dogs out of shelters 

Evaluating the animal            

Transportation of animals                 

Making phone calls to coordinate           

Conduct in-home visits

Financial contributions                                   

Serve on a Committee             

Participate at events promoting animal welfare                                                  

Participate at fundraisers             

Other:________________________    


 
Are you now or have you ever been a breeder? YES ____  NO____
If so what is your stance on breeding, health checks, frequency, etc. ________
____________________________________________________________
____________________________________________________________  
If not, do you have any breeding experience? YES ____  NO____
What are your views concerning puppy mills and back yard breeders? ________
____________________________________________________________
____________________________________________________________

Pets for whom I (we) are or have been the primary caregiver:

Type of Animal (i.e. dog, cat, bird): _____________  _______________  _____________  ____________    

Breed:                                                    _____________ _______________  _____________  ____________  

Call Name:                                           _____________ _______________  _____________  ____________                                                                                                                            

Sex (M/F)                                            _____________ _______________  _____________  ____________                                                                                                                           

Altered (Y/N):                                   _____________ _______________  _____________  ____________ 

Currently in the home:                   _____________ _______________  _____________  ____________              

No longer in the home:                 _____________  _______________  _____________  ____________   

Please use additional paper if needed and be sure to list all animals.                                                                                                                                                                                                                                                                                                                                                                    

For pets listed as not altered and/or  no longer in the home, please explain reason/circumstance:

__________________________________________________________________________
___________________________________________________________________________

If you have a spouse or live-in partner, how does that person feel about your involvement in any type

of rescue participation and do they plan to participate? ______________________

_________________________________________________________________________

Florida Keeshond Rescue may require a home check by a current Florida Keeshond Rescue  member.

Please initial here to show that you have read this requirement and agree to allow a home check.  ________

Provide two personal non-family references who can attest to your interest, interaction and feelings

about animals in general and dogs in particular:

1) Name: _____________________________Relationship: ________________

Phone: _______________ Address: __________________________________

City:____________________________ State: __________ Zip: __________

2) Name: ____________________________Relationship: ________________

Phone: _______________ Address: __________________________________

City:____________________________ State: __________ Zip: __________

If you have had pets at any time in the past, please provide a vet reference:

Name: _______________________________________________________

Phone: _______________ Address: __________________________________

City:____________________________ State: __________ Zip: __________

By signing below, I certify the information provided by me is true to the best of my knowledge and I

recognize that any misrepresentation of that information will result in my losing the privilege of being

officially associated with Florida Keeshond Rescue. I understand that this application will remain the

property of Florida Keeshond Rescue.

Signature: __________________________________ Date: _____________

Return completed form to: 

Florida Keeshond Rescue, Inc., June Hollingsworth, Director, 14286-19 Beach Boulevard, Jacksonville, FL 32250

Email: Hollikees@aol.com

This form may not be reproduced by other rescuers and/or groups. All copies of this document must carry this disclaimer.   R7.7.04