First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone*

Work Phone
x

Cell Phone

Applicants Date of Birth?*

Please provide 2 personal references. Include a phone number where they can be reached.*

What activities would you be willing to do for the animals in the care of Piedmont Pound Paws, Inc.?
Choose all that apply: Clean Cat House and areas where the cats live. Clean Dog Areas. Other. Socialize the Cats. Socialize the Dogs. Walk Dogs.

What other kinds of things would you like to do for Piedmont Pound Paws, Inc.?*

Are you willing to comply with all policies and regulations that Piedmont Pound Paws, Inc. must comply with in order to operate as a licensed rescue in the state of Missouri?*

Piedmont Pound Paws (PPP) is not making any representations or warranties about an animal's temperament or behavior. I acknowledge and agree that Piedmont Pound Paws is not responsible for any injury, damage, or harm caused by a PPP foster that I choose to foster or help with, and I hereby release Piedmont Pound Paws, Inc. from any and all liability: for any injury, damage, harm, expense, or liability I incur relating to fostering or volunteering for PPP. I also agree to indemnify Piedmont Pound Paws, Inc. from any and all such claims and to pay, without limitation, any costs related to such injury, damage, or liability, including, in the case of litigation, any attorneys' fees incurred by Piedmont Pound Paws in their defense. Please type your name and date:*

Please type the date and your name, again, to agree and comply with the requirements to volunteer or foster for Piedmont Pound Paws, Inc. Thank you. We will contact you regarding this application.*