P.O. Box 44176, Baltimore MD 21236
Contact us at Vicki@PetsOnWheels.org
Phone: (410)913-5569 Fax: (410)256-0171


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

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


*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.

Personal Information

First Name: Last Name:
Street address: City:
State: Zip Code:
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?


Other Possible Visitors

Name: Relationship:
Name: Relationship:


Emergency Contact

Name: Phone:


Pet Information

Breed:
Name:

Sex:  Male  Female            Age:           Weight:

Is your pet spayed or neutered?   Yes    No

Special Talents and or Training

Is the pet covered under your homeowners insurance?   Yes    No


Name of veterinarian:

Veterinarians phone number:

 

Print Name as Signature:
Date:



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