First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Alt Email

Primary Applicant's First and Last Name, and Age:*

What is your occupation? *

Please list the Name & Age and Relationship of every household member, including yourself

Myself (Name & Age)*

Household Member #2, if applicable (Full Name, Age & Relationship)

Household Member #3, if applicable (Full Name, Age & Relationship)

Household Member #4, if applicable (Full Name, Age & Relationship)

Household Member #5, if applicable (Full Name, Age & Relationship)

Household Member #6, if applicable (Full Name, Age & Relationship)

Please tell us about your current pets (or previous pets, if you don't currently have any).*

Preferred Method of Contact

What is your experience with German Shepherds or similar breeds?*

Animals may NOT be transported in the back of a pick up truck or other truck. They must ride inside the vehicle, tethered or inside a crate.

What type of vehicle do you drive?*

Drivers License number*

Any other information or comments that you would like to provide?

Please provide two to three personal references (we must be able to verify at least two of them)

Reference #1 - Full Name and Phone Number*

Reference #2 - Full Name and Phone Number*

Reference #3 - Full Name and Phone Number

Current Vet Clinic &/or Vet's Name * PLEASE CALL THIS VET AND AUTHORIZE THEM TO SPEAK TO HUGS **

Vet's phone number*

If you don't currently own any pets, but have in the past, please provide the name and phone number of your most recent vet

Most Recent Vet Clinic &/ or Vet's Name * PLEASE CALL THIS VET AND AUTHORIZE THEM TO SPEAK TO HUGS *

Vet's phone number

Have you ever been investigated for or charged with any type of animal mistreatment (including abuse, neglect or other cruelty)?*

Have you ever transported or fostered for other groups before? If so, please provide name of organization(s).*

How did you hear about us?*

Volunteer Agreement: By submitting this application, I certify that the information provided on this form is true and correct. I understand that as a volunteer for Heartland German Shepherd Rescue, I will provide my own automobile and health insurance, and hereby agree to not hold HUGS or any of its volunteers, associates, or foster care providers liable for any physical, emotional, or property damages that are a direct or indirect result of activities involved in the care, placement, transport, grooming, training, or evaluating of German Shepherd Dogs in any way associated with HUGS. This includes any and all activities I perform as a HUGS volunteer. I understand that there are inherent risks when dealing with any dog for HUGS, including but not limited to dog bites. I will read HUGS’s policies, when provided for specific areas and circumstances, and agree to act in accordance with these policies while I am representing HUGS. I understand that I will be notified by the Volunteer Coordinator once I have been approved. By signing this document, I authorize HUGS to call my listed references and discuss my pet-owning and keeping abilities, to share that information with other humane groups, and to use and disclose information in a manner consistent with HUGS policies.

Primary Applicant (first and last name)*

By submitting this form, I hereby certify that I am at least 19 years of age, and that all information provided by me is true and complete.