Volunteer Application - Humane Society

Personal Information

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Cell Phone *

Home Phone

Email *

Emergency Contact

Name *

Relationship *

Primary Phone *

Secondary Phone

Volunteer Profile

Please describe any present or past volunteer work

Organization

Position

What type of animal experience do you have?

Are you volunteering to fulfill court ordered community service requirements? *YesNo

How many hours? *

Are you volunteering to fulfill community service requirement for graduation? *YesNo

What school? *

Advisor name *

Do you have any allergies or physical conditions that might affect your volunteer work? *YesNo

Please explain *

Please check the duties you are willing to perform *Cleaning cat environments (cages, litter boxes, cat trees)Walking dogs/bathing dogsRestocking (some heavy lifting may be involved)Ground’s clean-up (litter pick-up, trimming shrubs/weeds, clearing walk ways)Unfolding newspaper/Envelope stuffingGeneral cleaning (washing walls, floors, etc.)Light maintenance (changing light bulbs, painting etc.)Off- site fundraisers or activities

Volunteer Acknowledgment

Check each box to confirm the acknowledgement of each statement *I acknowledge that volunteer hours are from 9-11 a.m., unless otherwise specified by HSRC.

I acknowledge that I must call to schedule an appointment to volunteer and walk-in volunteers are not accepted.

I acknowledge that if I miss 2 scheduled appointments without 24 hrs. notice, I will be dismissed from the volunteer program without notice.

I acknowledge that I am required to sign in at the beginning of each shift and sign out at the end of each volunteer shift.

I acknowledge that I am here to complete the tasks assigned to me and failure to do so may result in my dismissal.

I acknowledge that unprofessional behavior is not tolerated and will result in a dismissal of the volunteer program.

I acknowledge that any unprofessional behavior or concerns will be reported to my school advisor.

I acknowledge that any unprofessional behavior will be reported to my probation officer, county officials, or case worker.

Code of Conduct

I understand that if I exhibit behaviors considered by The Humane Society of Richland County staff to be dangerous to myself, the animals, volunteers, employees or citizens that I will be asked to leave the premises without further notice.

Please initial that you have read, understand, and accept the statement above. *

Photo Release

I understand that public relations are an important part of volunteering a The Humane Society of Richland County; I therefore agree on behalf of myself, my heirs, assignees, guardians, personal or legal representatives, and executors, to allow The Humane Society of Richland County to use any and all photographic images, videos and/or audio recordings of or by me made in the connection with activities conducted by or at The Humane Society of Richland County. These photographic images, videos, and/or audio recordings are to be used solely for program documentations and/or publicity purposes without payment. The Humane Society of Richland County will use reasonable efforts to notify me, but such notification is not expected or a condition of use.

Please initial that you have read, understand, and accept the statement above. *

By signing below, I am stating that I have read and understand the conditions set before me regarding volunteering at The Humane Society of Richland County.

Applicant Name *

Applicant Signature *

Date

Liability Waiver and Release Agreement

The Humane Society of Richland County includes: officers, agents, employees, volunteers, contractors and board members in the following liability waiver and release agreement.

In consideration of being permitted to participate as a volunteer, participant and/or attendee by The Humane Society of Richland, I hereby agree that I will assume full responsibility for the death, personal injury, or property damage suffered or sustained by me as a result of or in connection with my participation as a volunteer, participant and/or attendee. I agree, therefore, to indemnify the Humane Society of Richland County from and against all damaged property suffered or sustained by me as direct or indirect result of my participation as a volunteer of my participation as a volunteer, participant, and/or attendee; even if such death, personal injury or property damage arise out of the negligence of the Humane society of Richland County. I further agree that I will not make any claims against, sue attack the property of or prosecute the Humane society of Richland County or any death, personal injury, or property damage, whatever the cause or place of the event giving rise to the claim, which I may suffer or sustain as a result of or in connection with my participation of as volunteer, participant, and/or attendee. In addition, I hereby release and discharge The Humane Society of Richland County from all actions, claims or demands that I now have or may hereafter have for any death, personal injury, or property damage arising out of or in connection with my being a volunteer, participant and/or attendee. This release of liability is intended to discharge in advance, the Humane Society of Richland County from and against any and all liability to me or any person claiming under, through or on behalf or either of me arising out of or connected in anyway with my participations as a volunteer, participant, and/or attendee even though that liability may arise out of negligence on the part of the Humane Society of Richland County. I further understand that the behavior of animals is sometimes unpredictable and that some domestic animals are capable of inflicting serious personal injury or death, as well as extensive property damage. Knowing the risks of handling domestic animals; nevertheless, I hereby agree to assume those risks and to release, indemnify and hold harmless Humane society of Richland County and persons mentioned above who might otherwise be liable for me for damages. It is understood and agreed that this indemnity, waiver and release of liability is intended to be binding on me and my heirs, distributes, guardians, legal representatives or assigns.

By signing below, I am attesting that I have read this provision carefully and fully understand its contents. I am aware that this is an indemnity waiver and release of liability and a contract between The Humane Society of Richland County and myself. I am signing at my own free will.

Applicant Name *

Applicant Signature *

Date