Name:

Date of Birth:

Address:

City:     State:     Zip code:

Home Phone:             Work Phone:

Email Address:

Occupation:

Years Employed:

Do you have a regular veterinarian?    Yes    No
****We will call your veterinarian as one of your references, so please fill in all information as requested.
Veterinarian's Name: 
Clinic Name:     
Clinic Address:      Phone: 

Please list two personal references

1. Name:  Phone: Relationship:

2. Name:  Phone: Relationship:

How many hours per week do you have available for volunteer activities?

What types of activities would interest you? (please check all that apply)

    Foster care (temporarily caring for a dog in your home)
            Do you rent or own?
            Do you have a fenced yard? Yes  No
            If yes - what type of fencing do you have? 

    Marketing

    Phone work (calling potential adopters regarding available dogs, calling their references, etc.)

    Evaluations of dogs being surrendered

    Staff booths at area shows / promotional events (hand out literature, talk to the public, etc.)

    Other:

About your current pets:
Are all of your pets spayed or neutered?   Yes    No
Are all of your pets current on vaccinations?  Yes    No
Are all of your dogs tested for Heartworm and given preventative?   Yes    No
Do you administer regular flea and tick preventative to your pets?   Yes    No
If you answered NO to any of the above 4 questions, please explain:

Please list all current pets that you have:

Do you have any experience working with and/or training dogs?    Yes    No  
If yes, please describe:

Please take a moment to tell us how you found out about GSRAW and why you would like to work with the German Shepherd breed in particular.  Also please feel free to add any relevant information as to why you have an interest in becoming a volunteer member with our organization.

German Shepherd Rescue Alliance of Wisconsin sincerely thanks you for your interest
on behalf of our past and future rescue dogs!!

Release:
By submitting this document, you are stating that all the information given herein is accurate and complete and that you are hereby giving your consent for GSRAW to verify any and all information contained herein.