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* 1. Your Name

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* 2. Mailing Address and Best Email 

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* 3. Best Phone numbers to reach you:

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* 4. How old will you be in June 2019, and where will you attend school in the fall of 2019? 

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* 5. Parent/Guardian Name/Phone

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* 6. Please list any medical issues/allergies that might impact your participation in daily activities working around children or animals: 

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* 7. Tell us about any animal/pet/children experience you have. (pets at home/babysitting/volunteering/etc). 

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* 8. List a reference or two, (Name/Phone/Email) other than a friend or family member. These references will be contacted to help us learn about you.  (Current/former teacher, clergy member, employee, etc).

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* 9. Why do you want to volunteer with us? 

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* 10. Which day will you attend Counselor Orientation? 

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