PALS Volunteer Info. Form

1. Please provide the following personal information:

Mr.    Mrs.  Miss  Ms.

First name
Last name
Middle initial
Street address
Address (cont.)
City
Province
Postal code
Work Phone
Home Phone
FAX
E-mail

2. Employer:

3. Occupation:

4. Age Group:     16-18 19-30 31-45 46-65 66+

5. In case of emergency, contact:

First name
Last name
Work Phone
Home Phone

6. How did you hear about PALS?

7. Why are you interested in becoming a PALS volunteer?

8. Please indicate the areas you would be interested in volunteering
(check ALL that apply):

Pet Visitation               Screening Pets            Fundraising  
Manning Info Booth      Newsletter Writing    Special Events   
Admin/Secretarial       Computer/Printing      Telephoning                         
Photography                 Artwork                    Video Taping                 
Volunteer training        Other                        

9. Please detail your experience in the volunteer areas chosen:

10. Days you are available: (No Pet Visits on Fridays)

Monday   Tuesday    Wednesday  Thursday 
Friday     Saturday   

11. Times you are available:

Morning   Afternoon  Evenings

12. Is there any day/time you are absolutely NOT available?

13. Have you had any experience as a volunteer, in a paid position,
or otherwise working with:

Children             Elderly    Physically Disabled 
Mental Health     Cognitively Delayed  

If YES, please provide details:

14. Please select areas of experience you have with animals:

Pet Owner      Obedience Trainer  Breeder
Vet Assistant  Other

16. Do you have any physical or medical limitations which may limit
the extent of your participation in PALS?

Yes No

If YES, please provide details:

17. Please describe any hobbies, skills, interests or languages spoken that
you would like us to know about:

18. Do you have your own transportation?     Yes No

19. Is there any additional information you would like us to know?

Please provide infomation about three references we may contact
(exclude immediate family):

Reference 1:

First name
Last name
Relationship
Work Phone
Home Phone

Reference 2:

First name
Last name
Relationship
Work Phone
Home Phone

Reference 3:

First name
Last name
Relationship
Work Phone
Home Phone