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 experience Are 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* Event Planning Grant Writing Graphic Design Public Relations Adoption Days Fundraising Journalism Graphic Illustration Donation Pick-up Photography Dog Training Class Assisting Web Design Phone Calls Grooming Media Relations Transporting Other If other, please specify Please check the days you are most able to volunteer your time* Select All Monday Tuesday Wednesday Thursday Friday Saturday Sunday Do 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
