"Yesterday we had the privilege of meeting a woman with disabilities. She said the pups made her problems disappear even if for a brief moment, and that we would be what she remembered from the day."
- Erin S., volunteer

Facility Coordinator Registration Form

Important! Please enter your information carefully - extra spaces, especially leading spaces, or not filling in all fields, will generate an error message.

General Information

First Name

Last Name

Username

New Password

Confirm Password

Address Information

Street Address

City

State

Zip Code

Contact Information

Email Address

Phone #(no dashes)

Other

Please list your facilities

I have read and agreed to the following terms*:

I am a Facility Coordinator of a facility visited by Pets On Wheels volunteers.
I agree to receive emails from Pets on Wheels.
I have read and agree to the Facility Coordinator Responsibilities.

*Failure to meet the terms above will result in your ineligibility to participate with Pets on Wheels.

Please note that if you have a space in front of any information in the entry fields, or if you left one of the fields blank, you will get an error message. If this happens, please go back and review your entries carefully, and remove any extra spaces or fill out any blank fields. Thank you!