Name*

Address*

City

State Zip

Phone (H)*

Best Time to Call

Phone (W)

Fax

Email*

Your Occupation

I want to help with:

Transportation of dogs
Checking pounds for available dogs
Checking homes for possible placement
Grooming
Training
Getting donations of dog food
Getting donations of bowls, collars, leads, shampoo, beds, crates, dog runs, etc.
Networking with local reps on an available dog listing
Other:

Will you need to borrow a crate?

Yes or No

I want to help with Fundraising by:

Helping with a raffle/auction
Finding donations of raffle items and collecting items
Making/creating items for donation or auction
Helping to find grants
Other:

I want to help with Education by:

Helping at an educational booth
Providing copies (xeroxes) of materials
Writing educational articles
Other:

I want to help with Advertising by:

Helping video/photo dogs
Writing advertising copy
Finding donors for advertising space
Other:

Do you have special skills? (web site knowledge, sew, knit, build, construct, crafts, sculpt, paint, write, calligraphy, photography, etc.

In consideration of PCA Inc Rescue., hereinafter the acceptance of my services as a Special Volunteer, I agree that I, my assignees, heirs, distributees, guardians, and legal representatives forever release and shall not make a claim against, sue, or attach the property of PCA Inc., Rescue, its officers, directors, volunteers, committee members, members, employees, agents, heirs, successors and assigns for any actions, causes of actions, suits, liabilities, claims, demands, damages or causes of any kind or nature whatsoever, whether presently existing or arising in the future, whether known or unknown, which arise out of or are based upon any fact, matter, claim or thing involving my services as a volunteer. I agree to indemnify and defend PCA Inc., Rescue , its officers, directors, volunteers, committee members, members, employees, agents, heirs, successors and assigns against and save them harmless from any and all demands, claims, causes of action, or judgments, and any and all expenses (including, withoutlimitation, attorneys fees) incurred in investigating or resisting the same, for injury to person, loss of life, or damage to property occurring during the term of my services as a Special Volunteer, and until all applicable statutes of limitation expire, arising out of any act, omission, or neglect of PCA Inc., Rescue, its officers, directors, volunteers, committee members, members, employees, agents, heirs, successors and assigns.

By submitting this application, I declare that all of the above information I have given is true and complete.

I would like a copy of this application sent to my email address above.