The Pet Connection in Mission, KS - Volunteer Questionnaire

Name (First & Last): *

Date of Birth (MM/DD/YY) *

Address: *

City: *

State: *

Zip Code: *

Cell Phone: *

E-mail Address: *

Home Phone: *

I am interested in volunteering to help with: *

Adoption center
Spay/Neuter clinic
Obediance/Behavior center
Foster care
Administrative...phone calls, filing
Transportation of animals throughout Kansas City area
Special events
Photography
Data Entry

Availability: *

Weekends/Daytime
Weekends/Evening
Weekdays/Daytime
Weekdays/Evening
Special Events Only

Please list any special skills or experiences/education that you think we should know about:

Is your volunteer service a requirement for school? *

Yes
No

Is your community service ordered by the courts? *

Yes
No

If ordered by the court, please list your offense (this is required before you can do community service)

If court ordered, provide the name & phone number of your court ordered probation/diversion officer (this is required before you can do community service)

Do you have any special medical, behavioral or developmental needs that we sholuld be aware of? *

Yes
No

If yes, what are they?

* Required