GENESEE COUNTY ANIMAL CONTROL

Walter Rodabaugh Chief Animal Control Officer G-4351 W Pasadena Ave Flint, MI 48504 phone: (810) 7321660 fax: (810) 7321493

VOLUNTEER APPLICATION FORM

Last Name _ _ _ _ _ _ _ _-', First Name _ _ _ _ _ _ _ __ Hadden Date Of Birth _ _ _ _ _ _-', Age _ _ __ . Address _ _ _ _ _ _ _ _ _ _ _ _ _City_ _ _ _.State_ _ Zip_ _ __ Home Phone _ _ _ _ _ _ _ Celf Phone_ _ _ __ Work Phone-_ _ __ Parent jguardian or sponsored agency signature if applicant Is under 18 years of age: Name , relationship_ _ _ __ Phone Signature_ _ _ _ _ _ _ _ _ __ Have you ever been convicted of a felony? If Yes explaln, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Do you have a record of arrest or conviction of any animal cruelty charge._ _ __ Emergency Contact: Last Name _ _ _ _ _ _ _ _ _ _ _ Flrst name_ _ _ _ _ _ __ Relatlonshlp_ _ _ _ _ Home Phone_ _ _ _CeIl Phone_ _ _ __ Do you have any special licenses or credentials that would be beneficial to this department _ _If yes explaln _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Do you have any animal care/handling back ground? _ _ _ If yes explain

Why did you decide to become a volunteer at the shelter_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Please list any other animal welfare agencies that you volunteer for

Please list any non animal agency that you have volunteered with

Any other Information that you would like to share,_____________________________________