Thank you for your interest in helping SCMR in the capacity of a volunteer. This document will provide information for our internal use only. It is understood that being accepted as a SCMR volunteer does not provide you with the authority to represent SCMR in any capacity, unless specifically requested to do so by a SCMR Director.

The volunteer agrees to abide by all policies and guidelines of SCMR, regarding the care and handling of any SCMR rescue.

PERSONAL INFORMATION

Name:

Age:

Address (no P.O. Box #):

City, State, Zip Code:

Home phone:

Work phone:

Cell phone:

Email address:

Spouse or Life Partner Name:

Spouse/Partner Email address:

Spouse/Partner Work phone:

Spouse/Partner Cell phone:

PERSONAL REFERENCE:

Person's Name:

Phone Number:

Address:

City, State, Zip Code:

VOLUNTEERING INTERESTS:

As a volunteer, in what capacity are you interested in helping SCMR, please select as many from the options below, if need be, use "other" to list your interests:

Web site development
Legal support
Administrative / record keeping
Fundraising
Accounting
Doing home visits
Checking references
Facebook/Twitter administrator
Other - explain:

VOLUNTEER INTERESTS INVOLVING CONTACT WITH OUR DOGS:

Will you pick up a dog from a home or shelter if that is needed?Yes  No

How far are you willing to travel to pick up a dog needing resuce?

Are you willing to participate in transport if one of our dogs needs to be moved across state(s)?Yes  No

Please complete the following questions if you answered Yes to either of the questions above. All others may skip to the signature section of the form.

List all other adults and children living in your home & provide Full Name, Age & Relationship:

List all children and their ages who visit your home (grandchildren, neighbors, etc.):

Do you have a fenced yard attached to your home?

Yes

If Yes, describe your fence, including material it is made of plus general size, condition, etc.:
    

No

If there is no fence, how you plan to potty any interim SCMR dog?
    

Are your dogs always supervised when they are outside?

Yes

No

    If No, explain:
    

Do you have a swimming pool? Yes     No

If Yes, is it fenced separately?

Yes     No

CONDITION OF MALTESE YOU MAY BE ASSISTING SCMR WITH:

Do you understand the temperament, socialization, grooming, health issues and proper care of a Maltese?Yes  No

If you have to pick up a dog that is coming into our rescue care, it may have ticks and fleas, have an illness or infection and badly matted hair. Is this a problem for you?Yes  No

VET REFERENCE:

Veterinarian Business Name:

Phone Number:

Address:

City, State, Zip Code:

All the information in this application is true and correct. I understand and agree to abide by the terms and conditions herein.

     Yes  No

Signed: _________________________

Dated: __________________

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If submitting this application online, please click on the button below. A signature is not required.

If you prefer to submit via snail mail, please sign and send to:

SCMR
P.O. Box 2005
Chattanooga, TN 37409

(updated: 07/10/10)