Pitt County Forms Center

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   4550 County Home Rd. Greenville, NC 27858  |  Telephone: (252) 902-1725

   Doggy Day Out Volunteer Information

   Must be atleast 18 years old to participate

4. First Name*
5. Last Name*
6. Date of Birth
   Date of Birth
8. Address*
10. City*
11. State
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
12. Zip Code*
14. Phone Number*
15. Additional Contact Number
17. Email Address*
19. Home Dwelling

    1. Home with fenced yard
    2. Home without fenced yard
    3. Apartment
20. Home Environment

    1. Dogs
    2. Cats
    3. Children aged 4 or less
    4. Children aged 5-9
    5. Children aged 10-17
21. Your Level of Experience

    1. Never owned a dog
    2. Owned a dog but have not completed obedience training
    3. Have completed basic obedience training with a dog
    4. Have completed intermediate training with a dog
23. Please check all that apply below
25. Type of Outings Planned

    1. Home/Apartment
    2. Hikes/Parks

    1. Coffee/Shopping
    2. Other
26. If other please explain..
28. Days of Week Preference

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
29. Energy Level Preference

    1. Low
    2. Medium
    3. High
30. Behavior Preference

    1. Easy
    2. Moderate
    3. Challenging
31. Dog Size/Weight Preference

    1. Small
    2. Medium
    3. Large
33. Needs
35. Any Additional Information You Would Like to Provide
37. Please Note*

    I understand Doggy Day Out volunteers are required to read and understand the Doggy Day Out Manual

    1. I agree.
39. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
41. Electronic Signature*
Leave This Blank:


43. Submit

* indicates a required field