Volunteer Application

ACTS - Assistance Canine Training Services
2928 East Conway Road
Center Conway, NH 03813
603-383-2073

IMPORTANT INSTRUCTIONS: Please read carefully

Please use your TAB key to move on to the next entry box.

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

Date*

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 TaxiOther

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? ( Wednesday @ 5:30pm or Thursday @ 10am at Telling Tails in Center Conway, NH.

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

Reference 1 Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Relationship to applicant*

Second Reference

Reference 2 Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Relationship to Applicant*

Third Reference

Reference 3 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*