Animal Care and Adopon Center
480 Cinnabar Rd, Chrisansburg, VA
Vol. Coordinator Signature Date
Oﬃce Use Only
Shelter Supervisor Signature Date
City State Zip
Supervisor Informaon (Parole Oﬃcer, etc.)
Name Phone 1
Signature of Parent/Guardian Date
Volunteer Signature (Over 18) Date
Approved Denied Supervisor Contacted
Date & Inials
How many hours are you required to complete?
Please describe your charges below.
Have you ever been charged with/convicted of animal neglect, abandonment, or cruelty?
Have you ever been charged with/convicted of assault, sexual assault, or other violent crime?