School/NHS/Other Community Service Hours
Thank you for choosing CVAS for your service hours! Please fill out the form below completely. Our Office Coordinator will email you with all the information needed. If you do not receive a response within 4 days, check your spam folder, and/or reach out to cvasoffice@cvas-pets.org
Email
*
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General Information
Name
*
First Name
Last Name
Phone Number
*
Birth Date
*
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Month
-
Day
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any limitations? (Ex. Allergies, heavy lifting, animal preference, special needs, etc.)
*
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Emergency Contact
Who should we contact in the event of an emergency?
Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Relationship to you
*
Physician Name
*
Physician Phone Number
*
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Educational Group
Name of Educational Institute/Group (Ex. School, church, etc.)
*
How many hours are you required to complete?
*
Day(s) & Time(s) Available
*
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Additional Information if Needed
If there is anything else you would like us to know, or anything else you may need (school project, skills, etc.)
Is there anything else you would like to provide?
Submit
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