Volunteer with PGI -

Date / Time *

Your information

Name *

First

Last

Are you a: *

A community volunteer
ISU Trainer
Bradley Trainer

What is your pronoun gender identity? Common pronouns include she/her/hers, he/him/his, and they/them/theirs.

DOB:

Are you over 18 years old?

Email *

Phone *

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you own your home? *

Upload a photo of the front, back and inside of your home *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

I live in a *

Single family home
Townhouse
Apartment
Other

Do you have a fenced yard? *

Yes
No

If you rent do you have permission of your landlord to have a dog on property?

If you rent, please unload proof of landlord approval (via email or direct communication)

Drag & Drop Files, Choose Files to Upload

Please list all people and ages of who lives in your home. *

Does anyone in the home have a disability? If yes please explain. *

Please list all animals and ages that live in your home. *

My current pets are (check all that apply) *

Dog friendly
Spayed/ neutered
Up to date on vaccinations
NA- I dont have any pets

How active is your family? *

Very activie- we have many visitors, chidlren and animals in and out of our home
Somewhat active- we have a few people visit
Quiet- our home does not see many animals, children or other visitors

Where do you plan to keep a dog? (check all that apply) *

In Family home – loose
In Family home- kennel
In back yard full time or more then 60% of the day
In a garage or kennel setting alone

Vet Name, City and Phone Number

Please upload proof of vaccinations for pets currently in home

Drag & Drop Files, Choose Files to Upload

If you are a student please list your family home address here:

Address Line 1

Address Line 2

City

State

Zip Code

If you are a student, do you have parent approval to have a dog at this address?

Have you ever been convicted of animal cruelty or neglect? *

Yes
No

Are you over the age of 18 years? *

If no- how old are you?

My interest in PGI

Which programs are you interested in volunteering for? (check all that apply) **Any volunteer who will have the dogs in their home must complete a home check by our staff** *

How long are you able to keep a dog for in your home? *

If other…

Please list any relevant experiences you have that you feel would benefit any of the above programs or events. Include dog training experience and general dog care. *

What dog behaviors are you NOT willing to work on through with training with a new in your home? (check all that apply) *

Barking at noises around the home/ yard
Pulling on the leash
Barking in a kennel
Excited behaviors with visitors to the home
Chewing
House training
Fear of new people or things
Car sickness
*** I understand the dogs are in training and I am willing to work on all these behviors with a new dog to my home

How many hours a day would a dog be left alone?

How many hours per week would you be able to dedicate to dog training? *

What days of the week are you available? *

Are you available Tuesday nights for trainings? *

Yes
No

Are you interested in getting certified to handle our service dogs in vest in public settings? *

Yes
No
Unsure at this time

Are you avilable on Tuesday evenings for training? *

Yes
No

How did you find out about our organization? *

If other…

Please list a personal reference. Name, phone and email.

Disclaimer

Disclaimer *

By signing this I understand Paws Giving Independence reserves the right to deny any applicant for any reason. I understand Paws Giving Independence does not have to give me a reason for a denial of an animal. In my participation with Paws Giving Independence and Helping Paws I do hereby agree to hold free from any and all liability the Paws Giving Independence/Helping Paws and its members, staff members, trainers, board members, volunteer staff, volunteers and officers. My family, members of my household and myself waive the rights and claims for damages and injuries, which may come from connection and participation with PGI. I declare myself to be physically sound to participate with the PGI. I understand PGI can remove a dog from my home at any time due to failure to fulfill these terms, conditions, policies, and procedures of Paws Giving Independence. I understand any dog that is placed with me through Paws Giving Independence will legally belong to Paws Giving Independence. By listing my vet information I am giving PGI permission to contact them.

Inspection/ Rights of PGI *

I understand that Paws Giving Independence and the IL Department of Agriculture has the right to come and inspect my home if needed at any time without notice. PGI may also remove a dog at any time for any reason. PGI can remove me as a volunteer at any time for any reason.

Photo Release

I hereby authorize and grant permission to Paws Giving Independence to reproduce my first name (or my child) and/or photographic image, and/or any video footage of me, provided such photograph or video shall have been taken by Paws Giving Independence, or obtained by them either from me or with my consent. I agree that such reproduction may be edited as desired. I consent to the use of my first name, photographic image, video footage and biographical material about me in any promotional materials. I represent that I have the right to enter into the Agreement and that my rights I have granted in this Agreement will not violate any commitment or understanding I have with any other person or entity. I agree to indemnify and hold harmless Paws Giving Independence, its officers, members, executors, assigns, and/or any other parties or entities employed by it in relation to the usage of the aforesaid information against all claims, losses, expenses and liabilities of every kind including reasonable attorney’s fees, arising out of the inaccuracy or breach of any provision of this Agreement. I expressly release Paws Giving Independence, its officers, members, executors, assigns, and/or said other parties or entities from any and all claims arising out of the use of my first name and/or photographic image and/or video footage. This Agreement represents the entire understanding of the parties and shall be permanent unless revoked by me in writing. Should I wish to revoke this agreement, I may do so by writing to Paws Giving Independence at PO BOX 9572, Peoria, IL 61612-9572.

Signature

Clear Signature

Volunteer with PGI

Did you want to get involved in PGI? We have many opportunities and would love your help!

Your information

My interest in PGI

Disclaimer