Short-Term Volunteer Youth Release Statement

Please remember: This form must be completed prior to volunteering. This form is NOT for court ordered hours. Daily Tasks May Include: Socializing our shelter pets Laundry Cleaning throughout the shelter (inside & outside) Organizing storage areas Providing animal baths or other grooming Gardening DRESS CODE (check with supervisor for working interviews) Must wear pants (no shorts) Mandatory: No sandals or flip-flops. Please wear rubber-soled, closed-toed shoes. No tank or tube tops, no bare midriff showing No revealing and/or offensive clothing Please note that clothes may get dirty and/or be exposed to bleach Please feel free to contact or email Kirstin at any time Phone 352-873-7387 ext 204 ktanner@thehsmc.org

Volunteer's First Name *
Volunteer's Last Name *
Volunteer's Date of Birth *
Parent/Guardian's Full Name, Relation & Phone Number *
*	I, as the parent or legal guardian of the Volunteer listed above, acknowledge and understand that my son/daughter/ward’s acceptance as a volunteer is at the sole discretion of the Humane Society of Marion County, Inc. (hereinafter referred to as “the Humane Society”). If accepted, I agree that my son/daughter/ward will comply with all rules and regulations established by the Humane Society, and I understand that failure to do so may result in the immediate termination of their volunteer role.
*	I acknowledge that my son/daughter/ward’s services are provided strictly on a volunteer basis, without pay or compensation of any kind, and without liability of any nature on behalf of the Humane Society. I understand that all services performed by my son/daughter/ward are at their own risk.
*	I recognize that handling animals and performing other volunteer tasks involve inherent risks. I understand that physical harm, including but not limited to animal bites, scratches, cuts, bumps, bruises, accidents, and other injuries, may occur. On behalf of myself, my son/daughter/ward, our heirs, personal representatives, and executors, I hereby release, discharge, indemnify, and hold harmless the Humane Society, its agents, servants, and employees from any and all claims, causes of action, or demands of any nature, including legal costs and attorney’s fees, arising out of any injuries or damages that may be incurred or sustained by my son/daughter/ward while volunteering.
*	I also understand that public education and outreach are important functions of the Humane Society. On behalf of myself, my son/daughter/ward, and our heirs, personal representatives, and executors, I grant the Humane Society permission to use any photographs or videos taken of my son/daughter/ward during their volunteer work for promotional, educational, or public use.
*	I confirm that I am digitally signing this waiver voluntarily and under no duress. By digitally signing, I attest that the information provided is true and accurate. I understand that my son/daughter/ward must adhere to the Humane Society’s dress code and all policies in order to participate as a volunteer.
Signature *	Clear
Parent/Guardian's Typed Name *
Todays Date *