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Volunteer Registration Form

Thank you for your interest in becoming a Pals for Life volunteer! Please fill out the following form, by entering your information in the given spaces. When you are finished, please click on 'Submit' to send the form directly to us. Be sure to include your phone number, address, and email, so that we can contact you. Thanks again....we look forward to hearing from you!


Please complete the following information:


* Denotes Required Field
*Name:
Organization:
*Address:
*City: *State: *ZIP:
*Email:
*Phone (Day):
Phone (Night):

Programs you are interested in:

Visitation programs
Education programs
Writing
Benefit Committee
Special Events
Typing, Office work, etc.
Other (please specify):


Times available: days     evenings     weekends

Can you provide your own transportation? yes     no
If no, do you have access to public transportation? yes     no

Do you have experience with pets? yes     no
If yes, what types of pets?


Do you have a pet you would like to bring to pet programs?
yes     no

If yes, please fill in the following:

Type of pet:  Breed:
 Name:               Age:

Are you allergic to pets? yes     no
If you are, please specify:


Do you have any medical restrictions? yes     no
If you do, please specify:


How did you hear about Pals for Life?



Seniors & Students - $10.00 Individuals - $15.00
Family(3 or more members) - $40.00
Temperment Test - $10.00/Pet

Thank you for completing the volunteer registration form! Don't forget to hit 'submit' below, to send us your information. If you have any questions, please call us at (610) 687-1101, or email us at PalsforLife@juno.com.