Junior Volunteer Application

Your Name (required):

Date of Birth (required):

Address (include city, state and zip (required):

Employment Company Name / School Name / Occupation:

Job Title and Description:

Primary Phone (required):

Secondary Phone:

Your Email (required):

NOTE: By giving us your e-mail address, you agree to receive newsletter e-mails from us.

In case of emergency, please notify: (required):

Relationship (required):

Emergency Contact Phone (required):

Ways you might be able to help:
 Office work (typing, copier etc.) Photography Arts/crafts Fundraising Cat Care Dog Training Dog Walking Outreach Cleaning

Do you have any physical, medical or psychological limitations or disabilities? (i.e., heart condition, mental illness, learning disabilities, back injuries, epilepsy, etc.) If yes, please explain:
 Yes No

T-Shirt size ($10.00 for volunteers):  S M L XL XXL

List any previous volunteer experience (Agency / Activity / Dates):

Why are you volunteering at Home at Last Humane Society?

 Help Homeless Animals Community Service Credit Placement w/Vocational Counselor (through school) Case Manager Court Mandated Community Service Other

If volunteering with Vocational Counselor or Case Manager what is their:

Name:
Phone:
Company name:

Volunteer work at the Shelter is not only animal-related, but does involve contact with the general public. What type of public-contact experience have you had?

List your specific skills and talents that might be useful in your volunteer work: (artistic, photographic, computer, language, animal handling experience, etc.):

What is your experience with dogs?  First-time owner Have had 1 or 2 Knowledgeable and experienced

What is your experience with cats?  First-time owner Have had 1 or 2 Knowledgeable and experienced

What other types of animals have you had experience with?

Please give the name of two (2) references that know of your abilities and interests – they may be personal, professional, volunteer or school references (include how you know them, their phone number and duties you performed if you worked for them):

Volunteer Questionnaire:
1. What attracted you to the Home at Last Humane Society?


2. Which opportunities interest you the most?


3. What are your goals as a volunteer at the Home at Last Humane Society?


4. What questions do you have for us?

In submitting this application I (print name*) , understand and agree to the following:

I will treat all animals, people, and property come in contact with at the Home at Last Humane Society with
respect I will refrain from using profanity and conduct myself with courtesy at all times.

I will be on time for my scheduled shift Accurate tracking of my volunteer hours directly aids in the Society’s ability
to obtain grants.

I agree to make contact with the Volunteer Coordinator should I wish to terminate my Volunteer services
will wear a Home at Last Humane Society and name tag while volunteering I will come appropriately dressed, wearing close-toed shoes, pants, and clothing appropriate for my position If I am wearing shorts or open toed shoes I may be asked to leave due to safety risks. For safety reasons, we ask that volunteers cover or refrain from wearing visible body piercings, except for ears.

I agree to be supervised by the Volunteer Coordinator or a designated staff person. If I feel that a communication problem exists between paid staff and myself I will report the problem to the Volunteer Coordinator as soon as possible.

I give Home at Last Humane Society (“HAL”) the right and permission to use my name, likeness, and voice, together with my endorsement or testimonial (whether written or oral), in all types of advertising and promotion This right and permission includes photographs, video recordings audio recordings, and all other media in which my name, likeness, or voice may be reproduced.

HAL will own any materials and inventions I prepare or make that are related to my job, whether or not made on my own time or in a volunteer capacity HAL will also own any materials or inventions I prepare or make during work or donated volunteer hours or using HAL resources or facilities I will sign any additional papers HAL requests to allow HAL to obtain patent, copyright, or trademark protection in its name for these materials and inventions.

I understand that as a volunteer I may gain access to information about HAL, customers, or staff that is confidential I agree to maintain confidentiality and to refuse disclosure of any information that is either private or personal.

Volunteering at the Home at Last Humane Society is at-will Active volunteer status at HAL may be terminated for any reason, with or without cause or notice, at any time by either parties-the volunteer or HAL I understand that if I have no reported hours for six (6) months, my active status as a volunteer will be removed.

In submitting this application I hereby agree to all terms and conditions set forth in this agreement.

This agreement is entered into with Home at Last Humane Society (HAL) jointly by the undersigned (print name*)
, in order to permit the Volunteer to participate in the In-Shelter Volunteer program. This Agreement is for the benefit of HAL and each of its staff member’s employees, officers, directors, agents, and representatives (known individually as an “Indemnitee” and collectively as “lndemnitees”), Volunteers have been advised that the activity of working with the shelter animals is hazardous and involves contact with animals that are unpredictable. As such, Home at Last Humane Society cannot be held liable for injuries or accidents that may occur as a result of working with the animals. Volunteers understand that the following are some, but not all, of the risks associated with working with shelter animals:

• Bites or scratches from dogs, cats, rabbits, rodents, and birds
• Being knocked down or pulled excessively by a dog
• Injuries relating to wrist/hand/fingers from a dog leash
• Slips/trips/falls resulting from wet floors/kennels or equipment
• Hitting heads on objects such as cage doors/kennel walls/hose boxes, etc
• Water or cleaners sprayed in eyes
• Injuries resulting from cage doors, equipment, etc.
• Flea/tick bites or ring worm infestation
• Internal or external parasites
• Zoonotic illnesses (human illness contracted from animals)
• Animal illness exposure to animals at home
• Injuries related to lifting animals, food, litter, or equipment
• Injuries caused from grooming equipment-such as clipper blades, shears, driers
• Exposure to cleaners, latex gloves, bleach, parasite control products
• Exposure to or incidents relating to the public (outbursts, inappropriate contact)
• Exposure to or incidents relating to the volunteers (outbursts, inappropriate contact)
• Loss of personal property
• Any type of damage to car while parked on HAL grounds
• Damage to clothing from animals, cages, chemicals, etc.

Volunteers are aware that injuries, loss of or damage to personal property, and death may occur as a result of Volunteer’s participation at the shelter Volunteers agree that HAL and lndemnitees shall not be held responsible or liable for any personal injury or other injury, including death, damage, loss, or expense to Volunteer or his/her property, whether or not such injury, death, damage, loss, or expense is caused by negligence of HAL, any Indemnitee, or a third party.
Volunteers and their heirs, executors, and administrators agree to hold harmless each indemnitee against any and all manner of legal actions, such as suits, debts, claims, or liability of any kind incurred while the Volunteer participates at, the shelter.
Volunteers fully, completely, and unconditionally waive and release each Indemnitee from all rights, liabilities, duties, claims, charges, demands, actions, damages, costs, attorney fees, or expenses of any kind that Volunteers may have now or in the future against HAL or any Indemnitee relating to participation at the shelter.
Volunteers represent and warrant that he/she is physically and mentally fit to safely work with animals and public at the shelter Should an accident or other medical emergency occur while participating at the shelter or while Volunteer is en route to or from HAL-sponsored events and HAL staff members are unable to timely reach Emergency Contacts for medical authorizations, then Volunteer hereby gives consent for HAL staff members to authorize necessary hospitalization and medical treatment, including but not limited to, injections, anesthesia, surgery, and medication.

Volunteer represents and warrants that Volunteer has current medical insurance coverage and agrees to be responsible for any and all billings and debts incurred with respect to such medical treatment or services.

Volunteers represent and warrant that each of them has the authority to enter into this agreement.

If any provision of this Agreement is found to be unenforceable in any way, it shall be enforced to the maximum extent possible and all other provisions of this Agreement shall remain in full force and effect.