Montgomery County SPCA
SPCA Rd, PO Box 484, Amsterdam NY 12010
518/842-8050 www.mc-spca.org facebook firstname.lastname@example.org
The Montgomery County SPCA (MCSPCA) is a non-profit charitable organization funded primarily through donations. Our purpose is the prevention of cruelty to animals, the promotion of education of current and potential pet owners about responsible pet ownership. We welcome the participation of those willing to represent our organization in accordance with our mission and philosophies.
Please print legibly, so that your information is recorded correctly into our database:
Address __________________________________________City___________________ Zip________
Phones (Home:) ________________(Work:) ________________ (Cell:) ___________________
E-mail (please print legibly)________________________________________________________
Employed at ___________________________________________________ Retired_____
Allergies or Physical Restrictions _________________________________________________________
Year of Birth _____________________
Why do you want to volunteer at the MCSPCA _______________________________________________
Are you volunteering to acquire hours for school? _______
Are you volunteering to acquire hours for alternative community services? ____
Have you volunteered for other animal welfare organizations? _______
If yes, what organization(s) did you volunteer at? ____________________________________________________
Please list any pets you currently own (or have owned in the past) so we may know what kind(s) of animals you are comfortable with:
Would you be willing to volunteer off the MCSPCA premises? (for example to represent the MCSPCA at an outside event) Yes No
Can we add your name to our email list for MCSPCA’s monthly newsletter? ________
In case of emergency, please contact:
Name: ___________________________________Relationship to you: ______________________
Home phone: ________________Work phone: ________________
¨ The MCSPCA recommends that all volunteers be current on their tetanus vaccination.
¨ Confidentiality: Your information will not be shared, except in the case of another staff member or volunteer wishing to reach you for a work-related purpose. All volunteers are expected to maintain confidentiality of any personal information of members, customers, staff or volunteers which they encounter in the course of their work here.
Notes: Please let us know about your skills, experience and interests that would be relevant to the shelter
Job selections (please circle):
Walking dogs ~ Bathing dogs ~ Socializing cats ~ Grooming cats
Cleaning dog kennels ~ Cleaning cat cages ~ Washing Dishes
Washing/Folding Laundry ~ Washing floors ~ Washing walls
Mowing lawn ~ Snow clearing ~ Cleaning van ~ Computer data entry
Off-site Adoption clinics ~ Fundraising events
Time commitment (the commitment is for two hours one day a week):
Please circle the day(s) you are available to volunteer (it will help us place you when you are most needed):
Sunday ~ Monday ~ Tuesday ~ Wednesday ~ Thursday ~ Friday ~ Saturday
Starting at 8AM to 4PM, what timeframes are you available?
Volunteers are most needed in the early morning.
I will notify the shelter staff member in case of necessary absence, and I will notify the Shelter Manager of my intent to discontinue this time commitment.
I confirm that the information provided on this application is correct. I understand the commitment involved and acknowledge that my services are offered at my own risk. I agree to adhere to Montgomery County SPCA policies and carry out my duties as a volunteer effectively. I understand that I must be at least 14 years old, to volunteer on the shelter premises.
SIGNATURE ________________________________________________ DATE ______________
Thank you for your interest in volunteering. You will find it rewarding.