PERSONAL INFORMATION

NAME:

ADDRESS:

COUNTY: Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia DeSoto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Miami-Dade Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Sumter Seminole St. Lucie Sarasota Suwannee St. Johns Santa Rosa Taylor Union Volusia Wakulla Walton Washington

CITY: STATE: Florida Georgia Alabama Louisiana Other ZIP:

HOME PHONE: WORK PHONE: CELL PHONE:

E-MAIL:

PLANNING ON MOVING IN THE NEXT... 3 Months 6 Months 1 Year Over 1 Year Not Moving

IF MOVING, DO YOU PLAN ON MOVING OUT OF STATE IN STATE

YOUR AGE RANGE: Under 18 18-20 21-25 26-35 36-45 46-55 56-65 66-75 Over 76

FOR STATISTICAL PURPOSES WHAT ARE THE OCCUPATIONS OF ALL ADULTS IN THE HOUSEHOLD:

ARE YOU OR YOUR SPOUSE WITH THE MILITARY? YES NO

IF YOU ANSWERED YES TO BEING IN THE MILITARY ARE YOU ACTIVE INACTIVE/RETIRED

IF YOU HAVE VOLUNTEERED WITH OTHER RESCUES PLEASE LIST THEM HERE.


PAST EXPERIENCE AND TRAINING

HAVE YOU EVER BEEN BITTEN OR ATTACKED BY A DOG? YES NO

DID THE BITE REQUIRE MEDICAL ATTENTION? YES NO

IF THE BITE REQUIRED MEDICAL ATTENTION, PLEASE EXPLAIN:

ARE YOU COMFORTABLE APPROACHING A DOG YOU DO NOT KNOW? YES NO

DO YOU UNDERSTAND THAT DOGS MAY BE UNPREDICTABLE AND THAT SHRF, INC CANNOT GUARANTEE THAT A DOG WE ARE ATTEMPTING TO RESCUE WON'T BECOME AGGRESSIVE? YES NO

ARE YOU WILLING TO ASSUME THE RISKS INVOLVED WITH WORKING WITH ANIMALS WHO ARE SOMETIMES FRIGHTENED AND WHO ARE IN UNFAMILIAR SURROUNDINGS AND THE POSSIBILITY THAT THE DOG MAY BECOME AGGRESSIVE AND/OR BITE YOU OR A COMPANION? YES NO

DO YOU HAVE EXPERIENCE/TRAINING IN ANY OF THE FOLLOWING DOG-RELATED AREAS OF WORK?
(check all that apply)

Breeding

Grooming

Kennel Assistant

Animal Rescue

Training

Vet Tech

Pet Store Sales

OTHER EXPERIENCE AND SKILLS THAT WOULD HELP YOU IN RESCUE:

PLEASE DESCRIBE THE NATURE AND EXTENT OF ABOVE WORK/TRAINING EXPERIENCE?

PLEASE EXPLAIN OR DESCRIBE ANY OTHER INFORMATION WHICH YOU FEEL IS RELEVANT OR IMPORTANT ABOUT YOURSELF:

WHAT TYPE OF SERVICES HAVE YOU PERFORMED IN THE PAST, OR ARE PERFORMING NOW, FOR OTHER VOLUNTEER AGENCIES?


PLEASE LIST DOG CLUBS/RESCUE ORGANIZATION MEMBERSHIPS PAST AND PRESENT:

PLEASE LIST POSITIONS HELD OTHER THAN GENERAL MEMBER:

HAVE YOU EVER OWNED A SIBERIAN HUSKY? YES NO

HAVE YOU DONE ANY RESEARCH ON SIBERIAN HUSKIES?(check all that apply below) YES NO

I HAVE OWNED A SIBERIAN HUSKY I HAVE READ BOOK(S) ABOUT THE BREED

I HAVE DONE RESEARCH ON THE INTERNET I HAVE READ THE SHRF HUSKY ED PAGES

A FAMILY MEMBER OWNS A SIBERIAN HUSKY A FRIEND OWNS A SIBERIAN HUSKY

I HAVE TALKED TO PEOPLE WHO OWN HUSKIES

HAVE YOU EVER BEEN CONVICTED OF ANIMAL CRUELTY OR HAD A COURT ORDER AGAINST YOU PREVENTING YOU FROM OWNING OR BEING NEAR ANY ANIMALS, EVEN FOR A SHORT PERIOD OF TIME? YES NO

IF YES, PLEASE DESCRIBE:

PLEASE DESCRIBE WHY YOU ARE INTERESTED IN VOLUNTEERING FOR A GROUP DEDICATED TO RESCUING DOGS, PARTICULARLY THE SIBERIAN HUSKY?

APPROXIMATELY HOW MANY HOURS PER WEEK TOTAL DO YOU HAVE AVAILABLE FOR VOLUNTEER ACTIVITIES?

Please indicate what you would be interested in doing as a volunteer for the Siberian Husky Rescue of Florida, Inc. (you can select more than 1 option):

ANIMAL CONTROL LIAISON

LETTING RESCUE KNOW OF SIBERIANS IN NEED IN YOUR AREA

DOING REFERENCE CHECKS AND HOME INSPECTIONS OF POTENTIAL ADOPTERS IN YOUR AREA

IDENTIFYING DOGS REPORTED IN YOUR AREA AS PURE SIBERIANS

PROVIDING TRANSPORT SERVICES TO THE RESCUE

WEB SITE MAINTENANCE/DESIGN

COMPUTER GRAPHICS/DIGITAL PHOTOGRAPHY

ADMINISTRATIVE/OFFICE WORK

RETURNING PHONE CALLS OR EMAILS

PR/FUNDRAISING/MARKETING ACTIVITIES

OTHER (Please Describe)

By filling out this Volunteer Application I/we the undersigned are aware that this does not guarantee me/us a volunteer position with Siberian Husky Rescue of Florida, Inc. If I/we are accepted I will remember in all my dealings with the public that I represent SHRF, Inc. and will act pleasantly and answer questions politely or refer persons to someone who can. If I/we are not accepted to be a volunteer I/we will not misrepresent myself/ourselves as a volunteer and collect donations, applications or do any other activity Siberian Husky Rescue of Florida, Inc. as an organization is involved in or participates in.

Would you you be willing to sign a 'waiver and releases of liability' if you are approved to be a volunteer for SHRF? YES NO

Do you have and can you provide proof of a valid FL driver's license? YES NO

Do you have and can you provide proof of valid auto insurance? YES NO

I have accurately completed this questionnaire, have read the above warning, and appreciate the risks in working with rescue dogs. I understand that SHRF, Inc. cannot be responsible for the actions, behaviors and or medical condition of the dogs that it seeks to rescue and I agree to assume the risks implicit in working with dogs, which may have been abandoned, beaten, otherwise mistreated, or abused, or who may suffer from an illness, condition or disease.

SIGNATURE OF APPLICANT:

DATE:

SIGNATURE OF CO-APPLICANT:

DATE:

All Fields must be complete in order to submit form.