We appreciate your application. Please complete this form for the SPCA. Click on "submit" when ready to send.
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
Your Name: Dog's Name: Address: City, State, Zip: Telephone Number: E-mail address:
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)
