MCHS Volunteer Pet Transport Form
Questions marked by * are required.
1.
First Name and Last Name: *
2.
Email: *
3.
Home Address including city, state and zip code: *
4.
Home/Cell Number. Please list 2 phone numbers where you can be reached: *
5.
Day & Time Available for Transporting *
6.
Which pets can you transport: *
Dog
Puppy
Cat
Kitten
7.
How many pets can you safely transport? *
8.
I can transport to (check all that apply): *
Local vet in Fayette, AL
Resue Org. outside my state
Rescue Org. within my state
Within 25 mile radius of my address
Within 50 mile radius of my address
Within 100 mile radius of my address
9.
What type of vehicle do you have to transport pets in? *
Car
Truck w/no camper shell
Truck w/camper shell
Truck w/extended cab
SUV
Van
10.
I prefer to transport under these conditions. Please check all that apply: *
Daylight driving
Night time driving
Daytime only
Night time only
Clear weather
Rain
11.
Do you require gas funds? Check all that apply: *
Yes
I require funds up front
I will accept a reimbursement by submitting my odometer reading
No
I am willing to donate 1/2 the gas expense
I will need a receipt for my tax records
12.
A representative of the Marion County Humane Society will contact you within 24 hours. Must be approved before transport. Please enter your name showing you understand and have read this form. *