Volunteer Application

Last Name*
First Name*
Date of Birth*
MM slash DD slash YYYY
Email
Secondary Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Main Phone*
Alternate Phone

Emergency Contact*
Relationship
Emergency Contact Phone*
Was your last tetanus shot within the last five (5) years?*
- Yes
- No
- I don't know
Legal Name / Signature*
By filling out my full legal name below it represents my signature and recognition of the possible risk in working with animals and that it can lead to injury. I understand and assume responsibility of any and all liability and risk in volunteering with CDR. I waive and release CDR and its agents and representatives from any and all claims which may accrue to me arising out of or in connection with being a volunteer.
Prefix First Middle Last Suffix
Is the volunteer applicant under the age of 18?*
- Yes
- No
Parent/Guardian Signature*
By filling out my full legal name below it represents my signature and I hereby give permission for the applicant to be transported and treated by a doctor in case of emergency or accident.
Prefix First Middle Last Suffix