Beesley's Paw Prints Volunteer Application

Thank you for your interest in the Beesley's Paw Prints program.

As a volunteer you will be working with United Way Partner Agencies, schools, and retirement communities using the therapeutic qualities of animals to improve mood and reduce stress for children and adults.

You can take a senior animal from Gulf Coast Humane Society to a retirement community, or use your trained therapy dog to work with children and adults at various locations.

First Name *

Last Name *

Street Address *

Address Line / Community

City *

State *

Zip Code *

Best Phone Number to Contact *

Email Address *

Company Name

Are you a full time resident? *

If seasonal, What dates are you here? *

Preference time for volunteering? Days, weekends, evenings? *

Date of Birth MM/DD/YY *

Gender *

Shirt Size *

Are you fluent in any languages besides English? *

If yes, which language(s)

Do you have registered or certified therapy dog?

If yes, pet's registration number

If no, do you have a dog that you would like to become a therapy dog?

If yes, which organization is he/she registered with? Alliance of Therapy Dogs, Pet Partners, or another group?

Dog's date of birth, if known, or approximate age (min. 1 year)

Dog's call name

Dog's sex

Dog's breed or mix

Dog's weight

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Your completed application form will be forwarded to Volunteer Manager

Beesleys@UnitedWayLee.org - 239.433.7204
United Way of Lee, Hendry, Glades, and Okeechobee

7273 Concourse Drive, Fort Myers, FL 33908

Volunteer Fair	HSIN Meeting	Friend/Family
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United Way Website	Newspaper	Flyer or posting
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