HSNWGA Volunteer Application (Revised 4-8-24)

Thank you for offering your time! Once submitted, our Volunteer Coordinator will review your application and contact you by email upon approval. All volunteers must be over the age of 18. If age 16-18 yrs. of age, parent or legal guardian approval is required. Age 12-15 may volunteer, but parent or legal guardian approval is required and they must be on premises when youth is volunteering. Due to insurance requirements, those under age 12 may not volunteer.

I am the volunteer 18 years of age or older and have read and understand the age requirement listed above. * If you are not 12 or over please do not continue. We cannot accept volunteers under age 12 for liability reasons. However many help by raising money, blanket, food and toy drives. We would love your help. You do not have to fill out this application to contribute in other ways.

I am the parent/legal guardian of the volunteer age 12-18 and have read and understand the age requirement listed above. Parent/legal guardian must compete the volunteer application. *

Volunteer's First Name *
Volunteer's Last Name *
Volunteer's Birthdate: *

Parent/Legal Guardian First Name (If volunteer 12-18)
Parent/Legal Guardian Last Name (If volunteer 12-18)

Address *

City *

State *

ZIP *

Volunteer's Home Phone Number
Volunteer's Cell Phone Number

Parent/Legal Guardian Phone Number (Volunteer 12-18)
Is this a home, cell, or work number?

Email address of volunteer over age 18 or parent/legal guardian. *

Emergency Contact Name *
Emergency Contact Number *

Do you have any disabilities that would need to be accommodated? *

If you answered yes, please explain.

Have you ever been convicted of the following: Cruelty to Animals; Sexual Offense; Theft; Drug Offense; Alcohol Offense? List all that apply. Multiple selections allowed. * Please select any of the following offenses for which you have been convicted. Multiple selections are allowed.

Are you volunteering to fulfill a court ordered community service program? *

If you answered yes, please list your probation officer's name and phone number.

If you are volunteering as a community service worker, please list details of offense.

THREE Kennel Shifts per Day, 7 Days a Week. AM Shift: about 7:30am-10:30am; DAY Shift: about 11:30am-2:30pm; PM Shift: about 5:30pm-8:30pm. Please select all the days and hours you prefer to volunteer. (Multiple Selections Allowed) *

Are you interested in helping with dogs? *

Are you interested in helping with cats? *

If you answered Yes for both cat care & dog care, which would you prefer helping? *

Helping Out at the Shelter - General Cleaning, Sorting Newspapers, Laundry. *

Bathing and Grooming Animals *

Are you interested in escorting visitors on adoption days? Adoption days and hours are: TH 10 AM - 2 PM; Fri 2PM - 7PM; Sat 10 AM - 2 PM * Adoption days and hours are: TH 10 AM - 2 PM; Fri 2PM - 7PM; Sat 10 AM - 2 PM

Office/Secretarial *

Are you interested in fostering animals? *

Planning or Helping Out at Events *

Do you own pets or have you previously owned pets? *

Please list pets you previously or currently own.

Please list previous experience working with animals. *

Why do you want to volunteer with us? *

Please list any previous volunteer experience. *

I agree specifically, and in light of the State of Georgia Emergency Shelter in place order, agrees to indemnify and hold HSNWGA harmless from any and all injuries, damages, incarceration, illness or death related to the COVID-19 virus. Further, I agree to indemnify the HSNWGA for any fines that may be assessed relating to compliance or non-compliance, or otherwise. *

This is my official signature that I am over 18 and agreeing that I have read and understand the Volunteer Waiver. *

This serves as official signature of Parent or Guardian of Minor under age of 18 that I am agreeing that I have read and understand the Volunteer Waiver. The parent and/or natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian. *


OFFICIAL VOLUNTEER WAIVER: I acknowledge that this volunteer work (working with animals) carries with it the potential risks of serious injury and property loss. I hereby assume all of the risks of participating and/or volunteering in this work. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from the dangerous propensity of simply unpredictable animals and their instincts or otherwise or from possible defective equipment or other safeguards, maintained or controlled by them or because of their possible liability without fault. I certify that I am physically fit, have no physical reason to refrain from said work and have not been advised otherwise by a qualified medical person that I cannot participate. I acknowledge that this Accident Waiver and Release of Liability form will be used by the HUMANE SOCIETY OF NORTHWEST GEORGIA, INC., OR ANY OF THEIR EMPLOYEES AND/OR VOLUNTEERS to exculpate them from any and all liability associated therewith. In consideration of my application and permitting me to participate in this work, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: A) Waive, release and discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me, the HUMANE SOCIETY OF NORTHWEST GEORGIA, INC. and the following entities or persons: Their directors, officers, employees, volunteers, representatives, and agents; B) Indemnify and hold harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my or any actions during said duration of my volunteering. I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and/or illness during this event. I understand that at this event or related activities I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and/or assigns. The HUMANE SOCIETY OF NORTHWEST GEORGIA, INC. is not obligated to provide a placement, nor are you obligated to accept the volunteer position offered. The Volunteer Coordinator of the HUMANE SOCIETY OF NORTHWEST GEORGIA, INC., with the approval of the officers, has the right to ask any volunteer to leave the organization without prior notice if he or she determines said volunteer is not following policies and procedures as set forth by the HSNWGA. The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I hereby certify that I have read this document and I understand its contents.*

Date Form Submitted *

*Checking This Submit Box Serves as my official signature that I am agreeing that I have read and understand the Volunteer Waiver. Effective Date: Dated Stated at the time of the Submission of This Form