First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone
Alt Email
Text/Pager Email
Are you over 18 years of age?*
Please list a person to contact in case of emergency*
Relationship
Best contact number
Name and address of employer
Type of employment
Position
If student, What school do you attend?
Grade level
How did you hear about us?
Why do you want to volunteer?
Have you previously served as a volunteer for Koby's Promise?
If so, when and what did you do?
Reason for leaving
Have you volunteered for other animal groups?
If so, please list other groups and dates
Do you have a dog or cat?
If pet is no longer with you, what happened to him/her?
If so, please describe
Do you have specific skill that you think would be useful to Koby's Promise? (e.g., Public relations, Computer skills, Carpentry, Clerical skills, Dog grooming or training, Medical skills, etc.)
Please list your interest and skills
Have you or any household member been convicted of a crime?*
If yes, please explain
Are you applying to fulfill a community service requirement?
Is the community service ordered or a school requirement? Choose one: No Yes - Court ordered Yes - School requirement
If school requirement, what school and what class?
Please list 2 personal references Name, relationship and phone number
approximately how many hours per week are you available to volunteer?
Please check the days/times you may be available to volunteer
Check areas of most interest to you
Please type your full name as a signature that you agree to abide by the mission, rules, regulations, policies and procedures of Koby's Promise while you are a volunteer.*