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Please complete this form and return it to the SPCA. Thank you.
GOLDEN OUTREACH VOLUNTEER QUESTIONNAIRE
SPCA Of Westchester, Inc.
590 North State Road
Briarcliff Manor, NY 10510
Tel: 914-941-2896 ext. 11, 12, or 13 fax 941-4728
Name ________________________________
Your Dog's Name ______________________
Address ______________________________
Telephone Number _____________________
City _________________________________
State _____________ Zip Code _______________
How did you hear about the Golden Outreach Program?
___________________________________
What type of health care facility would you like to visit?
__________________________________
When and how frequently are you able to volunteer your
time to Golden Outreach?
__________________________________
Do you plan to use a shelter dog? Yes No
If you plan to use your own dog, please tell us about him/her.
__________________________________
__________________________________
__________________________________
Has your dog ever acted aggressively toward anyone? Yes No
If Yes, please explain. __________________________________
__________________________________
What is your work experience?
__________________________________
__________________________________
(you must be at least 18 years of age to volunteer for this program)
___________________________________
Signature
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