Today's Date

Name

Date of Birth

Address

City

State

Zip

Email Address

Home Phone

Cell Phone

Work Phone

Have you ever personally owned a dog? Have you ever personally owned a dog? Yes No

How would you like to assist Waldo’s Muttley Crew Rescue? How would you like to assist Waldo’s Muttley Crew Rescue? Administrative Adoption events Contacting area businesses for donations Dorm Fostering Fundraising Transporting dogs to a vet or an adoption event Writing newsletter or grants Other

Please tell us about other ways you wish to assist.

By entering your initials in this field, you certify that the information you have given is true, and you understand that Waldo's Muttley Crew may contact your veterinarian, personal references and landlord (if applicable) to verify the information on this form.

Emergency Contact (First & Last Name):

Emergency Contact Cell Phone #:

Emergency Contact Alternate Phone #:

Signature (type full name)

Signature of Guardian (if volunteer is less than 18 years old)