"*" indicates required fields PERSONAL INFORMATIONName* First Middle Initial Last Permanent Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Enter Email Confirm Email Birth Date* Month Day Year Home Phone*Cell Phone*HOUSEHOLD INFORMATIONIf any, please list family members who have applied, or will apply, to be an Agape volunteer. (We do request that each family member over the age of 18 fill out an application to volunteer. This helps Agape maintain an accurate volunteer database. If needed, please attach a sheet of paper with family information)Do you have any family members who have applied, or will apply, to be an Agape volunteer?* Yes No Full Name First Last Over 18? Yes No Full Name First Last Over 18? Yes No Full Name First Last Over 18? Yes No Have you previously volunteered for Agape Animal Rescue & Training Center?* Yes No If Yes, please list the event date(s) and time(s)Have you previously volunteered for any other organization?* Yes No If Yes, please list the organization along with your volunteer experienceAre you volunteering to satisfy a requirement for volunteer hours through school, work, or other groups?* Yes No If Yes, please explain what program you are working through, how many hours are required, and any other information you feel we should knowWhat about animal rescue interests you?*Please select the following areas of interest* Events Transporting Donation Pick-up Photography Grooming Other If other, please specifyIf Transporting for Agape, you must have a valid driver's license. Do you? Yes No Please check the days you are most able to volunteer your time* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Select AllDo you prefer morning or afternoon opportunities?* Morning Afternoon Please list one emergency contactName* First Last Email* Phone*Relationship*As an Agape volunteer, I agree to hold harmless Agape of any damages resulting from my volunteering. This includes bodily harm as well as damages to a resident animal or personal property.I agree to the terms and conditions as stated. By selecting "I agree" I am acknowledging that all information provided is true and accurate* I agree I do not agree Please check the box below Share This Facebook Twitter Email
