Form

First name

Last name

Phone number

Email*

Street address

City

State/Region

Are you able to help with transporting animals or equipment either via your own vehicle, hiring a car service, or taking public transportation?

Yes, I have access to a vehicle.

Yes, but I do not have access to a vehicle. I am open to paying for a car service or taking public transportation.

Do you have prior volunteer experience with any animal or non-animal related organizations?

Yes

If yes, please describe the organization and your role/experience.

Have you or anyone in your family ever been charged or convicted of animal abuse or neglect?*

Yes

If yes, please explain, or write n/a*

Is there anything else you would like us to know about you?

I certify that I am at least 18 years of age or older and that ALL of the above information is true to the best of my knowledge. I certify that discovery of any false information will void any opportunity. I have not been convicted of any charges of cruelty, abuse, or neglect to animals and am not engaged in any commercial breeding or sale of dogs. I give permission to Hearts & Bones Rescue to verify all information and check references if requested. By entering your name in the box below, you are effectively providing your signature, indicating that all of the information on this form is true and accurate, to the best of your knowledge.*

Yes

Enter Name & Date*

Date of birth