Last name:

Street address:

Address line 2:

City:

State:
 

Zip:

Home phone:

Work phone:

Cell phone:

Email address:

Place of employment:

Occupation:
  

Age (if under 18):

Days/hours available:

Desired start date:

Have you ever owned a dog?  Yes  No

Do you currently own a dog?   Yes  No 

If yes, list age(s) and breed(s)

What motivated you to request information on volunteering for Puppy Prodigies?

Please check the areas you're interested in volunteering for:

Puppy Cuddler
Secretary/Assistant
Clerical/Computer Work
Board Member
Record Keeper
Puppy Parties
Fund Raising
Running Errands
Puppy Bather/Groomer
Vet Tech
Grant Researcher & Proposal Writer
Legal Services
Public Relations/Marketing
Courier/Transportation
Social Butterfly
Handy Andy or Annie
Photographer
Videograher
Pooper Scooper
Launderer
Other

Please describe your talents and interests that you would like to share with us


Please provide a personal reference of a person who is not related to you,
but knows you fairly well.

Name:
 

Relationship:

Phone number:


Email address:

As a volunteer I give Puppy Prodigies permission to contact my reference for information. I also understand that Puppy Prodigies is not responsible for any incidental damage or injury which may occur to any person or property during my volunteer work with the program. If any person, including me, is injured or any property, including my own, is damaged, I will not hold Puppy Prodigies liable now nor will I make a claim against Puppy Prodigies in the future.

I authorize Puppy Prodigies to use and publish for marketing, advertising, promotion or other lawful purpose whatsoever, articles written, or photographs taken through any medium.