Online Volunteer Application

                     

 

 

Name: *
 
Address: *
 
Address (2):
City: *
 
State: *
 
Zip: *
 
Home Phone: *
 
Cell Phone: *
 
Email:
 
Age: *
 
Birth Date: *
 
If under 18 years of age, name of parent/guardian:
A parent/guardian must fill out a volunteer application and come to orientation with all minors. : *
 
Anyone under the age of 15 MUST have a parent/guardian assisting while volunteering: *
 
Are you attending as part of a group? i.e. Aspire, Resource Center, Scouts:
How did you hear about the volunteer program:
Please share your skills and training: *





 
Please list additional skills & training:
Please list any hobbies or extra curricular activities you enjoy:
Do you have any physical or psychological limitations or disabilities that might hinder you from participation in some activities: *

 
If yes, explain:
Emergency Contact Name: *
 
Emergency Contact Relationship: *
 
Emergency Contact Home Phone: *
 
Emergency contact work/cell phone number: *
 
How much time do you anticipate being able to volunteer: *





 
Please indicate days you expect to be able to volunteer: *
 
Please list up to four desired volunteer positions in order and your availability: *
 
Please explain your interest in volunteering with the Chautauqua County Humane Society: *
 
As a Humane Society volunteer you are required to commit a minimum of four hours per month for a minimum of six months to CCHS, do you feel you are able to keep this commitment? : *

 
Do you have current or previous volunteering experience with animals or another organization: *

 
Are there any animals that you are uncomfortable working with (i.e. large dogs,etc): *

 
If yes, please explain:
Are you allergic to any animals or chemicals, quat, etc...: *

 
Have you ever been convicted of a crime : *

 
If yes, please explain: