Volunteer Application

Contact Info

First Name

Last Name

Preferred Name/Nick Name

Phone Number

Preferred Phone Type

Street

City

State

Zip

Other (if not in US)

Tshirt Size (Unisex Size Type)

Date of Birth - mm/dd/yyyy

Please list any skills, strengths, or passions you possess that you feel might be of help to HSSA. If you are interested in TNR, please list that here as well.

Name of Employer

I am 18 or older

YesNo

My parent/guardian gives permission for me to volunteer; here is their contact information

First Name

Last Name

Phone

Emergency Contact

First Name

Last Name

Phone

Please read and agree to the following documents. In order to read the information and save your progress, please right-click the links and select "open in new tab". After reading information return to original tab to continue.

Five FreedomsHSSA Euthanasia PolicySpay/Neuter PolicyLiability WaiverConfidentiality Agreement

Is there any addition information that you'd like to inform us about, such as any physical or medical needs that we should accommodate for, or any allergies that might affect working with animals?

Have you ever been convicted of a crime?

YesNo

If yes, please describe the conviction(s), including the nature of the offense, whether you were charged as a minor or adult, and your rehabilitation since the conviction(s).

Are you currently on court-ordered probation?

YesNo

If yes, it is your responsibility to abide by the rules of your probation, including any restrictions on interactions with incarcerated persons. Select Department of Corrections crew members regularly contribute to HSSA’s programming and facility maintenance.

In checking the following box, I confirm that the information submitted above is true, accurate and does not contain any intentional misrepresentations in regard to my personal situation, professional situation, viewpoints, etc. Additionally I am agreeing to be contacted by HSSAZ regarding my interest in volunteering.

Yes I agree

Please Select ALL the volunteer opportunities that interest you. (Hold the Shift Key to select more than one.)

Please list any skills, strengths, or passions that you possess that you feel might be of help to HSSA.