Volunteer Application for:
Baltimore City/Baltimore, Carroll, Cecil, and Harford County.

Please note: ALL DOGS MUST BE DOG FRIENDLY

We do not screen pets until they are at least one year old and you must own your pet for 6 months before applying.

All volunteers must be 18 years old or older.

*Reminder: This chapter of Pets On Wheels covers Baltimore City, Baltimore County, Harford County, Cecil County and Carroll County. If you do not live in one of these county please do not fill out this application.

Indicates required field of this form

Personal Information

Are you 18 years old or older?   Yes    No

First Name:		Last Name:
Street address:		City:
State:		Zip Code:
Primary county you plan to visit in:	Baltimore City    Baltimore County    Harford County    Cecil County    Carroll County This application is for Baltimore City, Baltimore County, Harford County, Cecil County and Carroll County only.
Phone number:		Cell Phone:
Fax number:		E-mail Address:

Experience:

How did you hear about Pets On Wheels?

Emergency Contact

Name: Phone:

Pet Information

Breed:
Name:

Sex:  Male  Female             Age:

Name of veterinarian:
Veterinarians phone number:

Print Name as Signature:
Date: