ACC Volunteer Application

* Are you currently an ACC member?

I have applied for membership

No

Yes - how long?

* Are you 18 years of age or older?

yes

no

* Do you have Homeowner's or Renter's insurance?

yes

no

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

* Number of adults in household:

* Number and Age of children in household:

* How many CBRs do you currently own?

* Age and Sex 'status' of resident pets (ie: 9yr old, neutered male, cbr; 6 yr old intact female, cat; 4 month old intact male, rottie; 9 month old spayed female, cbr):

* Please check the areas where you are willing and able to help ACC help the CBRs in need.

Fostering

Evaluating Dogs in shelters

Evaluating Dogs in their current home

Performing Homevisits on potential adopters

Providing behavior help (for a CBR to stay in their original home and/or to help adopters)

Fundraising

Initial Phone contact with dog surrenderers

Initial phone contact with potential adopters

Transporting - How many miles?

* Are you willing to have an ACC rescue volunteer visit with you and your family?

yes

no

* Do you have other rescue experience?

no

yes - please supply the name of the organization(s)

List breed or All-breed club membership, other than listed above.

* Please check your area of expertise with Chesapeakes

* Please provide a vet reference. including name, and phone contact information (and email address if available).

* Please provide 2 other references - including name, and number (and email address if available).

* Do you agree to cooperate with the ACC Rescue Committee & volunteers by submitting any required reports or any other information that is necessary in the operation of the rescue program and to follow all ACC Rescue guidelines as set forth by the ACC Board of Directors?

yes

no

* Have you ever been convicted of any animal cruelty charge?

no

yes

* Valid Email Address as we will reply directly to this email addy

* Indicates Response Required