Cheryl Egerton President of the Basenji Club Of Canada
BASENJI CLUB OF CANADA
RESCUE PROGRAM
VOLUNTEER APPLICATION
Amy National Rescue Program Co-ordinator

                                                 DATE:_______________________________


NAME OF APPLICANT __________________________________________________________________________

ADDRESS ____________________________________________________________________________________

CITY/TOWN: _____________________________ PROV/STATE: _________ POSTAL/ZIP CODE: _____________

HOME PHONE (______)________________________ BUSINESS PHONE (______)__________________________

FAX PHONE (______)___________________________ CELL PHONE: (______)____________________________

BEST TIME TO CONTACT ME:  MORNING [ ]   AFTERNOON [ ]   EVENING [ ]   TIME: ___________

EMAIL ADDRESS ________________________________________

          ARE YOU A B.C.O.C. MEMBER?   YES [ ]   NO [ ]

          ARE YOU A MEMBER OF the CKC?   YES [ ]   NO [ ]

          DO YOU OWN A DOG WHICH IS REGISTERED WITH.....
		 the AKC?   YES [  ]  NO [  ]
		 the UKC?   YES [  ]  NO [  ]

          OTHER DOG ORGANIZATIONS/CLUBS?   YES [ ]   NO [ ]

          PLEASE LIST OTHER ORGANIZATIONS/CLUBS ________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

          ARE YOU A DOG BREEDER?    YES [ ]   NO [ ]

          ARE YOU A DOG OWNER?      YES [ ]   NO [ ]

          DO YOU OWN OTHER PETS?  YES [ ]   NO [ ]

          IF YES, PLEASE LIST: __________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

          ARE ANY OF THESE PETS "NOT" SPAYED/NEUTERED?  YES [ ]   NO [ ]

          IF YES, PLEASE LIST ___________________________________________________________________

___________________________________________________________________________________________
  
___________________________________________________________________________________________
    
          HAVE YOU BEEN INVOLVED WITH ANY RESCUE ORGANIZATIONS?  YES [ ]   NO [ ]

          IF YES, WHICH ONE(S) _________________________________________________________________

___________________________________________________________________________________________

          I WOULD BE INTERESTED IN VOLUNTEERING TO BE: (Check any which interest you.)

                 A PROVINCIAL CO-ORDINATOR  [ ]
                 PROVIDING FOSTER CARE  [ ]
                 PROVIDING DOG TRANSPORT  [ ]
                 DOG EVALUATION IN PRIVATE HOMES  [ ]
                 DOG EVALUATION IN SHELTERS/POUNDS  [ ]
                 CONDUCTING HOME VISITS  [ ]  FOLLOW-UP VISITS  [ ]
                 PROVIDING RESCUE COUNSELING  [ ]

          DO YOU HAVE ACCESS TO AN AUTOMOBILE?  YES [ ]   NO [ ]

          WHY DO YOU WANT TO VOLUNTEER FOR THE B.C.O.C. RESCUE PROGRAM? _______________________

___________________________________________________________________________________________

___________________________________________________________________________________________
 
          DO YOU CONSIDER YOURSELF AS A TEAM PLAYER?     YES [ ]   NO [ ]

          WHY? _______________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

          WHY DID YOU CHOOSE THE B.C.O.C. RESCUE POSTIONS LISTED ABOVE? _______________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

          COULD YOU MAKE YOURSELF AVAILABLE WHENEVER REQUIRED?     YES [ ]   NO [ ]

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
          I CERTIFY THAT ALL THE INFORMATION I HAVE GIVEN ABOVE IS TRUE AND CORRECT.
 I AGREE TO FOLLOW ALL THE RULES, PROCEDURES, AND CONSTITUTION OF THE BASENJI CLUB OF CANADA	 
                                               	     AND ITS RESCUE PROGRAM.
I WILL NOT HOLD THE BASENJI CLUB OF CANADA, ITS OFFICERS, AND REPRESENTATIVES RESPONSIBLE FOR
   ANY DAMAGE, INJURY, OR HARM CAUSED DIRECTLY OR INDIRECTLY TO ANY PERSON OR PROPERTY BY
                 	     ANY DOG WHICH I MAY DECIDE TO VOLUNTEER TO HELP.
   I AGREE THAT THE BASENJI CLUB OF CANADA, ITS OFFICERS OR REPRESENTATIVES, AT THEIR SOLE
      DISCRETION, RESERVE THE RIGHT TO REFUSE ANY APPLICANT FOR ANY REASON OR NO REASON.

By typing my name here, please consider this as my electronic endorsement of the veracity of this application.



     SIGNED___________________________________________________________________________
Instructions re. completing and Emailing the above form:
(1.) From the "Edit" drop-down list at the top of your browser (in which you are viewing this form), click on "Select all...."
(2.) From the same drop-down list, click "Copy". (This will now copy the form onto your computer's clipboard.)
(3.) Open your favourite word processor, such as "MS Word", "Open Office", or "WordPerfect".
(4.) Then open a blank document in your word processor. At the top of this word processor program, access "Edit", and click on "Paste". The form now appears in your word processor, and you can complete and edit the form at your leisure.
(5.) At any time, this form can now be "Saved As........", using the following file-naming format.... "YOURSURNAME.VolunteerApp". Ensure that it is stored in a convenient location on your computer where it can be found easily and readily used as an Email attachment.
(6.) Send an Email to Bob Brewster (the National BCOC Rescue Program Co-ordinator) with the Subject: field containing the phrase "YourSurname.VolunteerApp".
(7.) Attach the above saved file to this Email, and then click "Send".
(8.) An acknowledging Email will be returned to you when the application is read, processed, and filed.


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