form testing – Pay It Forward For Pets

[yop_poll id=”3″]

YOUR INFORMATION

First Name *

Last Name *

Phone *

Email Address *

Birth Date *

Street Address *

Apartment, Suite, Etc.

City *

State/Province *

ZIP / Postal Code *

Emergency Contact Name *

Emergency Contact Phone Number *

Relationship *

EMPLOYER INFORMATION

Are you currently employed? *YesNo

May we contact you at work? *YesNo

Employer's Phone Number *

Employer's Name *

Employer's Address *

Job Title *

Job Responsibilities *

VOLUNTEER / BACKGROUND INFORMATION

How did you hear about Pay It Forward For Pets? *

Have you ever volunteered with animals before? *YesNo

Where and for how long? *

Please describe the volunteer work you have done *

Have you ever been convicted of a crime? *YesNo

If yes, please explain *

Please list any physical or psychological conditions that may affect your volunteer work here

Please check the volunteer opportunities you would like to participate in *Animal Care - cleaning cages, bathing dogs, brushing cats, general cleaning.Dog Walker - walking dogs, taking dogs to the park, socializing dogs.Fundraising Volunteer - assist in planning fundraising events or represent Pay It Forward For Pets at an event.Foster Care - keeping pets in your home until ready for adoption. Note: this is a rare/random need.Other

What days would you like to volunteer? *SundayMondayTuesdayWednesdayThursdayFridaySaturday

How many hours per week do you plan to volunteer? *

Please list any special skills you believe might benefit PIFFP:

STATEMENT OF AGREEMENT / GENERAL RELEASE OR WAIVER

Please read carefully and sign

I am interested in serving as a volunteer for Pay It Forward For Pets and I am prepared to receive any necessary training and supervision to protect the animals and myself. I will hold Pay It Forward For Pets harmless if I incur an injury while working as a volunteer.

The undersigned volunteer (the “Volunteer”) realizes Pay It Forward For Pets is a non-profit organization and believes in the humane solution for homeless pets. The organization is dedicated to rescue efforts and saving the lives of pets in imminent danger of euthanasia. Additionally, spaying/neutering and adoption of homeless pets.

Volunteer assumes full responsibility for any and all injuries Volunteer may sustain while serving as a volunteer at the Pay It Forward For Pets Doggie Daycare and Overnight Boarding facility; as well as off-site when assisting with events.
Volunteer assumes full responsibility for any and all medical costs associated with injuries sustained as a Volunteer, whether “at or away” from the Pay It Forward For Pets Doggie Daycare and Overnight Boarding facility, subject to coverage under any medical insurance carried by the Volunteer personally or by the Volunteer’s employer.
Volunteer hereby RELEASES Pay It Forward For Pets from any all claims for personal injuries while a Volunteer at the Pay It Forward For Pets Doggie Daycare and Overnight Boarding facility or while performing volunteer activities at events away from the facility.
REMINDER: you must be 18 years old to volunteer. Anyone under the age of 18, must be accompanied by their parent or guardian when performing service hours at all times.

By agreeing, please type your name here: *

Please type the Parent or Guardian's name here if the volunteer is under the age of 18: *

Questions / Comments

Please do not fill in this field.

First Name *

Last Name *

Email Address *

Phone Number *

Questions / Comments *

Please do not fill in this field.

YOUR INFORMATION

Pet Owner's First Name *

Pet Owner's Last Name *

Phone *

Email Address *

Street Address *

Apartment, Suite, Etc.

City *

State/Province *

ZIP / Postal Code *

BASIC PET INFORMATION

Pet Name(s) *

Pet Age(s) *

Pet Breed(s) *

Pet Weight(s) *

Note: All dogs must pass an interview prior to enrollment in our Guest Services. With limited occupancy, we advise timely submission of this application to assure your reservation for ALL offered services.

I am submitting this application for *DaycareBoarding

DOGGIE DAYCARE SCHEDULE

How many days per week? *12345

Day Schedule *Full DayHalf Day

Starting Date *

BOARDING RESERVATION SCHEDULE

Start Reservation Date *

End Reservation Date *

REQUIRED BEFORE ADMISSION

Current veterinarian records are required for all interviews for enrollment. Please provide us with the name and phone number of your veterinarian for verification.

Veterinarian Name *

Veterinarian Phone *

When do you prefer to provide us with your current vet records? *I would like to provide all my vet records now.I will bring in copies of all my vet records to my interview. If I don't bring them, I understand that my dog will not be enrolled until I can provide them. Required records include the following: DHLPP, Bordetella, Fecal Test, Rabies Vaccine, Spay / Neuter, and Flea Control.

DHLPP Date *

This vaccination includes Distemper,Hepatitis,Leptospirosis,Parvovirus and Parainfluenza.Puppies under 12 weeks may only get DHPP.

Bordetella Date *

Fecal Test Date *

Rabies Vaccine Date *

Spay/Neuter Date *

Flea Control Date *

MEDICATION SCHEDULE

Prescription Name(s)

Dosage(s)

Time of Day

NUTRITION (OWNER SUPPLIED)

Brand of Food *

Feeding Schedule *

Quantity of Food for each feeding *

Do you have any special feeding instructions? If so, please explain here:

We provide organic treats on occasion. Would you allow your dog to have these treats? *YesNo

ALLERGIES

Environmental allergies? If so, please explain.

Food allergies? If so, please explain.

SOCIALIZATION

How well does your dog socialize? *None. I have no knowledge.Fair. Leash introductions only.Good. With familiar pets only.Excellent. Interacts great with all dogs in all settings.

Does your dog resource guard with any of the following? *NoneToysFoodKennel / Bed

Does your dog have a bite record? *NoneOnceMultiple times

Does your dog know any of the following commands? *SitStayLay / DownComeKissesHeelNone

Energy Level *CalmModerateHighObnoxious

This is an off-leash environment. Our goal is to socialize all guests. If your pet is not social, how do you envision his/her day while in our care?

Does your dog have any of the following physical restrictions? *NoneNo playingNo runningNo jumping

Does your dog have any other physical limitations? If so, please explain.

GUEST OPTIONS

Spa Treatments Options:Bath: Small to Medium Dog, 0-35lbs. - $25Bath: Large Dog, 35lbs.+ - $40Nail Trimming - $12None

Trail Walk Options:15 minutes - $1530 minutes - $25None

PET HANDLING

As a 501c3 Animal Welfare nonprofit organization, we utilize staff and skilled volunteers to accomplish the task of animal care and dog walking on the trails. We take the responsibility and safety of our Guests very seriously. All staff and volunteers are fitted with a cross-harness and a double leash with one being a slip-lead to prevent the escape of any Guest.

Yes, I have been informed that my dog may be walked by staff or a supervised volunteer. I understand unprecedented precautions have been made to ensure my pet’s safety. In the highly, unlikely event of an accident, I hold the designated volunteer and Pay It Forward For Pets harmless. Do you agree to this policy? *Yes, I agreeNo, I do not agree

By agreeing to our pet handling policy, please type your name here *

By not agreeing with our pet handling practices, please explain why here *

PET SAFETY

We need to know if we can seek medical attention for your pet if an unlikely, unfortunate situation occurs. I approve transport to Akron Metropolitan Hospital for emergency care in the unlikely situation where my/this pet becomes ill or injured. Payment of a medical condition is the pet owner’s responsibility UNLESS an injury was caused by an incident occurring on site at Pay It Forward For Pets, Inc. Do you agree with this policy? *Yes, I agreeNo, I do not agree

By agreeing to our pet safety policy, please type your name here *

By not agreeing with our pet safety policy, please explain why here *

Questions / Comments

How did you hear about us?

Save as Draft

Please do not fill in this field.