First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

What would you like to help with?

Other Position:

Are you 19 or over? *
Choose one: Yes No

What experience do you have volunteering? and have you ever volunteered with an animal rescue group?*

How many hours a week are you able to dedicate? *

If you are interested in helping with transport, how many miles can you drive at a time (round trip)? How often and what day(s) of the week work best for you?

For Transport: Please provide the color, make, and model of your vehicle, the license plate number, your drivers license number and expiration date:

Please provide a vet reference: Please list 2 references with names and phone numbers who are familiar with you and your current pets. Please do not list immediate or extended family members or anyone currently living in your residence. (Note: a couple does not count as 2 references, only 1.)*

Are there any questions we can help to answer?*

Please read the following and be sure you understand the following terms of this agreement. I understand that it is my decision whether or not to volunteer with Great Plains Pointer Rescue. I will not hold Great Plains Pointer Rescue responsible for any damage, injury or harm caused directly or indirectly by any dog I handle as a volunteer for any rescue program. I understand that it is not the policy of GPPR to reimburse costs in the rescue of dogs in any locality. The local club fund, adoption donations or local fund-raising efforts will contribute to reimbursement. I will not bring suit against Great Plains Pointer Rescue or GSPCA Rescue, its agents, volunteers, their heirs or estates in case of financial or other loss resulting from my activities as a rescue volunteer. I understand these terms and condition and give permission for Great Plains Pointer Rescue to speak with my/our references. name and date:*