Buckeye Boxer Volunteer Form

BBR Volunteer Form


First Name:
Last Name:
Address:

City:
State:
Zip Code:
Telephone Number:
Cell Phone Number:
Email:
Date of Birth:

How many people reside in your home (including yourself)?

Do you own/have access to a working automobile? yes no
Do you maintain auto insurance as required by Ohio state law? yes no
Do you understand that BBR will not be held liable should you be involved in a collision while conducting business for BBR? yes no
Do you understand that you will not be reimbursed for gasoline while conducting business for BBR? yes no

Would you be willing to house a boxer for a short period of time if necessary? yes no

Do you have a fenced yard? yes no		Type of fence:
If other, please expain:
If no, please explain how you will contain your foster Boxer:

Where wil your foster be kept while you are at home? If other, please explain:
Where wil your foster be kept while you are away? If other, please explain:

Do you currently own any pets? yes no
If yes, please provide the type of pet(s), breed(s), sex, altered or intact, age(s):

Have your current pets been socialized with other animals? yes no
Are your current pets dog friendly? yes no
Are your current pets up-to-date on their veterinary care? yes no

Please provide the following information for the veterinarian that has seen your pet(s):

	Name:
	Name of Clinic:
	Address:
	Telephone Number:
	Last Appointment:
	Reason for Visit:

In what ways would you be willing to assist BBR: If other, explain:

Please include any additional remarks or questions that you may have?