Volunteer – Adult Application

BASICS

Have you read and do you understand and agree to the guidelines?*

Yes
No

Have you ever been convicted of a felony?*

Yes
No

What charge and when?

Please list the jurisdiction, charge, date, and sentence for each offense.

Have you ever been convicted of a misdemeanor that involved animals in any way?*

Yes
No

What charge and when?

Please list the jurisdiction, charge, date, and sentence for each offense.

As a volunteer, privileged and confidential information, such as adopter or applicant contact information, may be released to you for use strictly in the course of your duties as a Pet Harbor volunteer. Do you understand all such information to which you are a custodian may not be divulged to anyone, including other Pet Harbor volunteers, for any reason whatsoever and may only be used for the professional and limited Pet Harbor purpose it was intended?*

Yes
No

Do you agree to maintain the highest level of confidentiality of such information and remove it from your possession as soon as you have completed the task for which you were given such information?*

Yes
No

Do you understand volunteering has absolutely no influence whatsoever on any adoption decisions and that should you apply to adopt, your adoption application might not be approved?*

Yes
No

Name*

First Last

Email*

We have a volunteer listserv where we post volunteer opportunities and other information for volunteers. Is the email address you listed above the email address you would like to be included in the listserv distribution?

Yes
No

We have an updater listserv where we post the updates from our adopters. Is the email address you listed above the email address you would like to be included in the listserv distribution?

Yes
No

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Home or Cell Phone*

Whatever number you use most

Work Phone

Occupation

Birth Date*

MM

DD

YYYY

REFERENCES

Veterinarian Name

Either the name of the doctor or the veterinary practice.

Full Name

Veterinarian Phone

Reference Name

Please choose someone who knows firsthand your character and love for animals.

First Last

Reference Phone

Reference Relationship

Reference Email (if any)

AFFILIATIONS

List your animal organization memberships (if any) with positions held.

If you currently volunteer or have volunteered for or been employed by an animal shelter or rescue, please list the entities.

Have you served on any committees you think would help us in offering you volunteer positions? If so, please list.

Have you chaired a committee or led other pertinent efforts?

Yes
No

INTERESTS

Describe areas of animal care-taking, administration, leadership, education, people interactions, etc., that particularly interest you.

Describe areas of animal care-taking, administration, leadership, people interactions, etc., in which you will not participate.

Describe areas of animal care-taking or administrative, leadership, people skills, etc., in which you have particular knowledge or expertise.

What other attributes do you think you can bring to Pet Harbor? For example, if you are a particularly organized person, this is where you tell us.

Which hours and days of the week are you willing to volunteer?

We understand this does not mean EVERY instance. For example, if you write "Saturday morning," we understand that does not mean EVERY Saturday morning.

Do you have allergies to cats or dogs?

Yes
No
Unknown

Do you have a vehicle you are willing to use to transport pets?

Yes
No

Do you have a valid driver's license?

Yes
No

Please describe any geographical limitations you have in driving.

Do you currently live with pets (dogs/cats)?

Yes
No

Please describe the pets.

Cats? dogs? Spayed/neutered? Breed? Age?

Comments:

Please let us know any other information you wish us to consider in matching you with volunteer tasks. Here is your chance to personalize this application. Information you may think doesn't matter might very well help us match your desires/talents with the right positions.

By indicating yes and submitting this form, I signify that all information given in this application is true and correct, to the best of my knowledge.

Yes
No

AGREEMENT*

In consideration of this opportunity to volunteer, I agree to the following terms and conditions, intending to be legally bound by them:

1. I will abide by the mission, rules, regulations, policies, and programs of Pet Harbor Rescue & Referral, Inc. (hereinafter "Pet Harbor") while I am a volunteer.

2. If I discontinue being a volunteer for Pet Harbor for any reason or upon Pet Harbor's request at any time, I will promptly return all of Pet Harbor's supplies, equipment, records, monies, and other items in good, clean condition.

3. I assume the risks of being bitten, scratched, injured, or frightened by cats, kittens, dogs, and puppies in connection with my volunteer work for Pet Harbor. Pet Harbor is not liable to me for any injuries, damages, liabilities, losses, judgments, costs, or expenses whatsoever which I might suffer or sustain in connection with the performance of my volunteer activities for Pet Harbor unless they are the result of Pet Harbor's gross negligence or intentional misconduct. I will indemnify, defend, and hold Pet Harbor harmless from and against any claims, lawsuits, injuries, damages, losses, costs, or expenses whatsoever sustained by any companion animal or any person in connection with my intentional misconduct or grossly negligent performance of volunteer activities for Pet Harbor or my breach of Pet Harbor's rules, regulations, policies, and programs.

4. I understand and agree that Pet Harbor may refuse volunteer applications for any reason.

5. I have accurately and truthfully completed this volunteer application and agreement.

6. Any modification to this agreement must be in writing signed by both parties. This agreement is binding upon me and my respective heirs, successors, assigns, executors, and personal representatives.

Yes, I agree.
No, I do not agree.

Phone

This field is for validation purposes and should be left unchanged.

Volunteer – Adult Application

Volunteer Application (Adult)

BASICS

REFERENCES

AFFILIATIONS

INTERESTS

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