ACC Shadow Application
Please fill out this form to apply for shadowing at Animal Care Center of Tupelo.
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Date of Application:  *
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Full Name: *
Age/Date of Birth:  *
Phone Number: *
Email Address: *
Preferred Start Date: *
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Availability: Days and Times *
How many hours per week are you hoping to commit?
Which were you hoping to shadow? *
Why are you interested in shadowing?
Are you applying as part of a school requirement or program?
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Have you had any previous experience or shadowing opportunities in the veterinary field? If yes, please describe. 
Applicant Agreement
By signing below, I acknowledge that: 
* I am voluntarily applying to observe veterinary professionals in a clinical setting. 
* I understand I will not perform medical procedures and that this is an observational role only. 
* I agree to follow all safety rules, wear appropriate attire, and maintain confidentiality. 
* I understand that participation is at the discretion of the clinic that may be revoked at any time. 

Please enter your name and date in the text box. 
 *
Parent/Guardian Consent Require for Applicants Under 18
* I give permission for my child to participate in the veterinary shadowing experience. I understand the potential risk and agree that the clinic, its staff, and affiliates shall not be held liable for any injury or accident that may occur during the shadowing/volunteering experience. 

*Please enter the parent/guardian name, contact number, and date to provide consent. 
 *
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