To Volunteer Yourself or your Child.... Would you please printout and fillout the following form, and mail it back to us, so that we can contact you.

Click Here to Print the People Volunteer Form..

OR Fill Out the Form Below completely:


Name:
Address:
City:
State:
Zip Code:
Name of Employer:
Daytime Phone:
Evening Phone:
Best Time to be Reached:
Availability:

Please Indicate with a check mark the day(s) and times you are available:

 
Mon
Tue
Wed
Thr
Fri
Sat
Sun
10:00am
11:00am
12:00pm
01:00pm
02:00pm
03:00pm
04:00pm
05:00pm

Consistency is exteremely important! What can you commit to?
Area(s) of Interest:

Please Check which Areas you are interested in volunteering for:

Pet Visits - Assisted Living Facilities(ALF)/Nursing Homes
Preferred Location?
Pet Visits - Bring another person's Pet to
Hospitals / ALF / Nursing Homes
Would you prefer...
Designated Area Visitation
Room-to-Room Visitation
Volunteer - Pet Bathing/Grooming
Volunteer - Office Help(clerical/phone calling/mailings etc.)
Volunteer - Fund Raising(special events etc.)
Volunteer - Phone Contact(calling volunteers etc.)
Volunteer - Volunteer Recruitment
Volunteer - Board Member
Volunteer - Team Captain/Managers

Volunteer Release Form:

I understand that Pet Therapy, Inc. is a non-profit volunteer
program to help Honor Our Elders, by providing love through pets, children and adults. I release Pet Therapy, Inc. from any responsibility due to injury or loss to myself and or youngster(s) or pet(s): occuring as a result of participating in Pet Therapy, Inc. scheduled visits to any care facility.
if you are filling this form out for a child, please list their name(s) here.
if you are filling this form out for a pet, please list their name, breed, and sex here.
I give Pet Therapy, Inc. permission to publish, or use for the public relations purposes any photo taken of me and or my pet (s) during a nursing home or scheduled photo shoot.
If I choose to have my youngster ride with a volunteer to and from a nursing home / assisted living facility, I accept responsibility that this is a personal arrangement / agreement made between myself and the other Pet Therapy volunteer as an individual and do not hold Pet Therapy, Inc. responsible..
Questions / Comments:

Thank you for your cooperation! Your help enables us to provide nursing home patients a pleasant stay and meaningful recovery.
We, and they appreciate your help.

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