Volunteer Application
First Name
Last Name
Address
City
State
ZIP Code
Email
Confirm Email

Please list all pets owned in the last 5 years

Name
Breed
Years Together
Age
Home Now?
Altered?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

If you have owned more than 3 pets or need more space for your pet history,
please use the text box below to complete the requested information.

Optional Veterinarian Information To Be Used as a Personal Reference for the Applicant.

Veterinarian Name
Street Address
Town or City

 Zip Code
Veterinarian Name
Street Address
Town or City
 Zip Code

IMPORTANT! Some vets require you to provide verbal permission before records are released to us. PLEASE CONTACT YOUR VET & ADVISE THAT ELEVENTH HOUR RESCUE WILL BE CALLING FOR A VET CHECK AND PROVIDE PERMISSION to release your record's.

Please describe any experience you have and/or what aspect of volunteering suits you best: (Fundraising, administration, dog handling and so on)

Personal References

Name
Phone Number
Relationship to You

Please note that only FULLY completed applications will be considered.
By clicking on the submit button below, I hereby give permission to the Eleventh Hour Animal Rescue to contact my veterinarian to obtain information about past and present pets. I also confirm I am 18 years of age or older and authorize the rescue to verify the above information.

Eleventh Hour Rescue shall not be held responsible for any damages, costs, or expense resulting from this placement; including, but not limited to, damage or injury to persons property. In this connection, Eleventh Hour Rescue is harmless from any and all liability of any and every nature and cause, directly and indirectly relating to the interaction of any dog.