Name *

First Name

Last Name

DOB

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

May we contact this Employer?

Yes

No

Do you volunteer at other animal rescue shelters?

Yes

No

Do you agree to pay for and have a background check?

Yes

No

What days are you available to Transport?

Mon

Tue

Wed

Thur

Fri

Sat

Sun

Applicant agrees that under NO circumstances will the dog or cat be sold, traded or given away regardless of any situations(s) that may arise or circumstance that occurs that prohibits them from keeping the dog or cat. The dog or cat MUST be returned to STAHR in the event that you are no longer able to transport the animal.

Agree

Disagree

Applicant agrees to comply with all laws and regulations concerning driving, including law pertaining to seat belts, cell phone use, and speed limits.

Agree

Disagree

Applicant will promptly notify STAHR of any physical conditions, vehicle defects or road conditions that might affect safety or the safety of the animals being transported.

Agree

Disagree

Today's Date

MM

DD

YYYY