Volunteer Application

Volunteer Application

Auntie/Uncle, Puppy Taxi, Canine Caretaker, General Volunteer
ACTS - Assistance Canine Training Services
2928 East Conway Road
Center Conway, NH 03813
603-383-2073
IMPORTANT INSTRUCTIONS: Please read carefully

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You must fill out this entire form in one session. If you leave your form will NOT be saved.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physical/Shipping Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Email*
example@example.com
What name do you prefer we use for correspondence and certificates?*
What volunteer position are you interested in?*

Auntie or UncleGeneral VolunteerPuppy Taxi
Do you have any dog training experience?*
Are you willing to take a dog into your home for a short time (one or two weeks)?*
If you are willing to take a dog into your home for a short time, please tell us who, in addition to yourself, lives in your home with you?
If you are willing to take a dog into your home for a short time, please tell us what pets live in your home.
If you are willing to take a dog into your home for a short time, please list any outdoor animals you have.
If you are willing to take a dog into your home for a short time,please tell us if you have a fenced in yard?
If you are interested in being an Auntie or Uncle, are you able to attend practice sessions? (Thursday @ 10am in Fryeburg ME, and Wednesday @ 5:30pm in Fryeburg ME
Are you or is anyone in your home a smoker? Do you smoke in the house or car?
Please list the skills and attributes you have to offer ACTS as a volunteer.*
Please tell us why you would like to volunteer for ACTS.*
References
Your references should help us decide if you have the character we require to receie one of our dogs. You should select people who are NOT your immediate family. References who can specifically speak to your character, your previous volunteer experience, your willingness to learn and take on a challenge, your ability to fullfill commitment, or your abilities as a dog owner are particularly helpful.
First Reference
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Relationship to applicant*
Second Reference
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Relationship to Applicant*
Third Reference
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Relationship to Applicant*
Are you willing to follow the rules and regulations as outlined by ACTS.?*

Yes
If you are interested in being an Auntie or Uncle, are you willing to attend the required practice sessions?*

Yes
Are you willing to represent ACTS. appropriately as outlined by their policies and procedures?*

Yes
ACTS requires volunteers to carry auto liability insurance on all personal vehicles that transport dogs. Do you carry personal auto liability insurance?*

YesNo
I acknowledge that by submitting my name and signing below, that all the above information is accurate.
Name*

First NameLast Name
Please sign and submit*

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