Hawaii Canines For Independence

Volunteer Application

 

Today's Date:________________

 

Name:_________________________ Home Phone:_______________

Address:_______________________ Work Phone:________________

______________________________

 

May we call you at work? __Yes __No

Please check your age group: __18-30 __31-50 __51-65 __65+

 

How did you learn about Hawaii Canines For Independence?

 

 

Please indicate the days and hours you are available for volunteer work:

 

 

Any additional comments about your schedule?

 

 

When can you begin volunteer work?

 

 

Please indicate the type of volunteer work you are interested in:

__Puppy Raising(3-9months)

__Dog Sitting(short-term)

__Dog Grooming

__Cleaning/Maintenance

__Dog Walking/Playing

__Office Work

__Fund Raising

__PR/Marketing

__Social Therapy Visits to Hospitals/Nursing Homes

__Special Occasions/Graduations

 

Please list any experience you have relating to the areas you checked:

How will your work with Hawaii Canines For Independence be of benefit to you?

 

 

How will your work with HCI be of benefit to our agency?

 

 

Do you work best when you...

__ initiate and follow through by yourself(after sufficient training), or...

__ receive ongoing direction

 

If you are employed, please list your employers name and address-

 

 

Please list two personal references:

Name_______________________

Phone_______________________

Address_____________________

 

 

Name_______________________

Phone________________________

Address______________________

____________________________

 

 

Volunteer Applicant Agreement

 

I declare that the above information is accurate.

I will not hold HCI liable for any injuries sustained while working for them.

I understand that if I am injured while acting as an unpaid member of the volunteer staff I am not covered by Worker's Compensation Law.

 

________________________ _______________

Signature & Date