PawsAbilities

Participation and Request Form

Select the items that apply, and then let us know how to contact you.

* denotes required information

Contact Information
Name*
Address*
City*
State*
ZIP*
E-mail*
Home Phone*
Work Phone
Age (if under 18)
Availability

Days and times you will be available (Please check ALL that apply.):

Friday, March 11, 2011 (Set Up)
12:00 p.m. - 4:00 p.m.
4:00 p.m. - 8:00 p.m.
Saturday, March 12, 2011
7:00 a.m. - 10:00 a.m.
9:30 a.m. - 1:00 p.m.
12:00 p.m. - 4:00 p.m.
Sunday, March 13, 2011
7:30 a.m. - 10:00 a.m.
9:30 a.m. - 1:00 p.m.
12:30 p.m. - 4:00 p.m.
Tear Down
4:00 p.m. - 6:00 p.m.

Job preference or limitations

Friends Who Would Like to Help

I have a friend that would like to help:

Comments

Contact

Susquehanna Service Dogs
Keystone Children & Family Services
3700 Vartan Way
Harrisburg, PA 17110
717-671-7813
ssd @ keystonehumanservices.org