Online Volunteer Application




Please Fill Out All Required Lines That Have An Asterisk *
Name: *
Address: *
Address (2):
City: *
State: *
Zip: *
Home Phone: *
Cell Phone: *
Age: *
Birth Date: *
If under 18 years of age, name of parent/guardian:
A parent/guardian must fill out a volunteer application and come to orientation with all minors. : *
Anyone under the age of 15 MUST have a parent/guardian assisting while volunteering: *
Are you attending as part of a group? i.e. Aspire, Resource Center, Scouts:
How did you hear about the volunteer program:
Please share your skills and training: *

Please list additional skills & training:
Please list any hobbies or extra curricular activities you enjoy:
Do you have any physical or psychological limitations or disabilities that might hinder you from participation in some activities: *

If yes, explain:
Emergency Contact Name: *
Emergency Contact Relationship: *
Emergency Contact Home Phone: *
Emergency contact work/cell phone number: *
How much time do you anticipate being able to volunteer: *

Please indicate days you expect to be able to volunteer: *
Please list up to four desired volunteer positions in order and your availability: *
Please explain your interest in volunteering with the Chautauqua County Humane Society: *
As a Humane Society volunteer you are required to commit a minimum of four hours per month for a minimum of six months to CCHS, do you feel you are able to keep this commitment? : *

Do you have current or previous volunteering experience with animals or another organization: *

Are there any animals that you are uncomfortable working with (i.e. large dogs,etc): *

If yes, please explain:
Are you allergic to any animals or chemicals, quat, etc...: *

Have you ever been convicted of a crime : *

If yes, please explain: