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Please complete the questions below. A link for your payment will be provided once you've completed the form.
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Email
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Name:
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Address:
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City:
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State:
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Zip:
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Phone:
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Employer:
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Birthdate:
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Some volunteer situations require strict confidentiality regarding patient medical records and/or working with minors. If needed would you allow Domesti-PUPS to conduct a background check (we would contact you for formal approval before proceeding).
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Have you ever been accused or convicted of abuse in any fashion?
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In order to fulfill our obligations with the facilities we visit, we request that you conduct two visitations per month. Would this be a problem for you?
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No
Domesti-PUPS often has FUN-raising events where we need the assistance of our volunteers. Would you be willing to assist with these events?
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Please list other organizations you currently volunteer with.
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