Wufoo

CTDR Volunteer Form

Please complete all fields. Fields with a * are required.

Date / MM / DD YYYY
Applicant's name * First Last
Applicant's age *
Applicant's address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary Phone * - (###) - ### ####
Work Phone - (###) - ### ####
Other Phone - (###) - ### ####
Email *
What's the best way to contact you? Best time of day? *
Is applicant employed full time or part time?
Applicant's employer
Co-applicant's name
Co-applicant's age
Is co-applicant employed full-time or part time?
Co-applicant's employer
Number of adults in home
Number of children in home
Children's ages
How can you help CTDR?
Conducting adoption interviews Performing home visits Pulling dogs from shelters Transporting dogs to vet appointments Transporting dogs to foster or forever homes Conducting vet and reference checks Helping with fundraisers Other
If Other, specify:
Has the applicant ever owned a dog?
Has the applicant ever owned a dachshund?
Please list your current pets (name, species, breed, age):
Please list your previous pets and why they are no longer with you:
What heartworm prevention do you use for your dogs?
Are your current pets spayed or neutered?
We require that any pets currently in your home be spayed/neutered and be current on their vaccinations. We require dogs in your home to be on heartworm prevention. We will be contacting your vet for a reference. Please give the name, address, and phone for your veterinarian. If you do not have current pets, please write n/a.

Veterinarian name
Veterinarian address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Veterinarian phone number - (###) - ### ####
Please give 3 references (name, address, phone) that are not related to you:

Reference 1
Reference 2
Reference 3
The information provided in this application is true to the best of my knowledge as of the date first shown on this application above. By typing your name below, you signify that you have filed this application and understand all that is contained within.
Do Not Fill This Out