Name * First Name Last Name Significant Other's Name (If applicable) First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Your Date of Birth * MM DD YYYY Your Occupation * Significant Other's Occupation (If applicable) What is your living situation? * - select an option - House Apartment Condo/Townhome Other If not listed, please explain your living situation. Do you own your home or rent? * - select an option - Homeowner Renter If you rent, please provide your landlord’s contact information. Do you have prior fostering experience or have specific animal training? Neither is necessary, but if so, please provide the name of the organization. * Please list names and ages of all in the household. Have any children living in your home lived with or been around dogs? Are you able to supervise or keep separate? Please describe their level of experience around animals. * Do you have any children, not listed in the household, visit your home and interact with your pets? Are you able to supervise or keep separate? Please describe what their level of interaction will be. * Please list all current pets, by name, in the household. Include: Name, age, species, gender and temperament. * Are all current pets up-to-date on rabies and other vaccinations? * - select an option - Yes No No current pets Please list your veterinarian, their address, and their phone number? (*Note we cannot process your application without this information. Please call the clinic and give them permission to speak with us.) * Please list your past pets by name and why you no longer have them. If they saw a different veterinarian than listed above, please include that veterinarian(s) and their phone number. * Do you do an annual heartworm test on your current pets? * - select an option - Yes No No current pets Do you use heartworm preventatives on your current pets? * - select an option - Yes No No current pets What is the name of the heartworm product being used? Do you use flea/tick preventatives on your current pets? * - select an option - Yes No No current pets What is the name of the flea/tick product being used? Are all your current pets spayed/neutered? If not, please explain why. * Do you have a fully enclosed fence? * - select an option - Yes No If yes, please describe height and style? Please describe the method or type of training you will use with animals. * What areas are you interested in volunteering in? * Event/fundraiser organizing Event dog handlers/walkers Intake transportation In-area transportation Adoption counselor or support Bathing, grooming or nail trims Gathering supplies Gathering event donations Securing sponsors Administrative work Photography Videography Other If not listed, please describe what area you would like to volunteer in. How many hours a week or month would you like to volunteer? * Please tell us a little about yourself. What are your interests or hobbies? * Is there anything else you would like to share with us about why you'd like to volunteer for Haven Animal Rescue Nebraska? Please list two references. Include: Name, relationship to you, their address, and their phone number. (*Only one of them may be a family member.) * I/We understand that by submitting this form I/we are certifying all questions have been truthfully answered and that this submission does not guarantee approval to volunteer with Haven Animal Rescue Nebraska. By submitting this application, I/we agree to hold harmless Haven Animal Rescue Nebraska when fostering/transporting an animal in my care. I/We agree to voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, that may be sustained by me or anyone as a result of volunteering, and/or any loss or damage of property. I/We also acknowledge that Haven Animal Rescue Nebraska is the current owner of all animals that I/we will be volunteering with and/or transporting. * I agree Thank you! We will get back to you as soon as we have reviewed your application! Volunteer Applicationhello@havenanimalrescuenebraska.org
