Name *

First Name

Last Name

Cell Phone *

We will use this phone number to contact you while you are on your field trip with our dogs.

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday of Handler *

Handler of the dog must be 18 years or older. Minors cannot complete this application but can accompany the handler on the field trip.

MM

DD

YYYY

Do you have any cats or dogs? *

Yes, 1 or more dogs.

Yes, 1 or more cats.

Yes, both cats and dogs.

No, I don't have cats or dogs.

If you have pets are they spayed/ neutered? *

If you do not have pets, please select 'no.'

Yes

No

If you have pets are they current on their vaccines? *

If you do not have pets, please select 'no.'

Yes

No

1st Personal Reference Name *

First Name

Last Name

1st Personal Reference Phone Number *

(###)

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2nd Personal Reference Name *

First Name

Last Name

2nd Personal Reference Phone Number *

(###)

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Have you ever been convicted of a violent crime towards humans or animals? *

Please be honest. We do have the right to run a background check on all volunteers.

Yes

No

I understand that any dogs I take on a Field Trip belong to Noah's Ark Animal Sanctuary and Clinic therefore, I must respect all directions given to me in regards to the care of the animal. *

Yes, I understand.

I understand that I must return the dog after the Field Trip at the time decided by the Noah's Ark staff unless prior arrangements have been made. *

Yes, I understand.

I understand that I cannot adopt the dog out to anyone while on the Field Trip but I can give people the link to the adoption application. *

Yes, I understand.

Date *

MM

DD

YYYY