Volunteer Application
  1. Your Name(*)
    Please let us know your name.

  2. Email(*)
    Please let us know your email address.

  3. Street(*)
    What is your street address?

  4. Apt.
    Invalid Input

  5. City(*)
    What city / town do you live in?
  6. State(*)
    Please select the state where you live

  7. Zip Code(*)
    What is your zip code?

  8. Home Phone(*)
    What is your home phone?

  9. Work Phone
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  10. Pet Information

    Please let all pets owned in the past five years


  11. Pet Name #1
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  12. Pet Type / Breed #1
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  13. Years spent in your home
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  14. Age of Pet #1
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  15. Is this pet currently living with you?
    Invalid Input

  16. Has this pet been altered?
    Invalid Input

  17. Pet Name #2
    Invalid Input

  18. Pet Type / Breed #2
    Invalid Input

  19. Years spent in your home
    Invalid Input

  20. Age of Pet #2
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  21. Is this pet currently living with you?
    Invalid Input

  22. Has this pet been altered?
    Invalid Input

  23. Pet Name #3
    Invalid Input

  24. Pet Type / Breed #3
    Invalid Input

  25. Years spent in your home
    Invalid Input

  26. Age of Pet #3
    Invalid Input

  27. Is this pet currently living with you?
    Invalid Input

  28. Has this pet been altered?
    Invalid Input
  29. Use the box below for information about any additional pets you've lived with
    Invalid Input

  30. Are you over the age of 18?(*)
    Please let us know if you are over the age of 18

  31. Veterinarian Information

    Some vets require you to provide permission before records can be released. Please contact your vet's office and give them permission to provide a reference and release records to 11th Hour Rescue New York.


  32. Name of Veterinarian
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  33. Street
    Invalid Input

  34. City
    Invalid Input

  35. State
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  36. Zip Code
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  37. Please describe your experience with pets and what skills you have to offer as a volunteer(*)
    Please describe your experience with pets and what skills you have to offer as a volunteer

  38. Personal References


  39. Name(*)
    Please input the name of reference #1

  40. Phone(*)
    Please input the phone number of reference #2

  41. Relationship(*)
    How do you know reference #1


  42. Name(*)
    What is the name of your second reference?

  43. Phone(*)
    What is the phone number of your second reference?

  44. Relationship(*)
    How do you know your second reference?

  45. Only FULLY completed applications will be reviewed

    By clicking on the submit button, I hereby give permission to 11th Hour Rescue NY to contact my veterinarian to obtain information about past and present pets. I also confirm that I am 18 years of age or older and authorize 11th Hour Rescue NY to verify this information.

    11th Hour Rescue NY shall not be held responsible for any damages, costs or expenses resulting from this placement, including, but not limited to damage or injury to persons or property. 11th Hour Rescue NY is held harmless from any all all liability of any and every nature and cause, directly and indirectly, relating to interaction with any dog.