PVCHS Volunteer Application AND Waiver
I am over 18 Years old
If you are not 18 or over please do not continue. We cannot accept volunteers under 18 for liability reasons. However many young men and women 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.
No
Yes
Date
First Name
*
Last Name
*
Address
City
State
ZIP
Phone
Email
Name of Business or Company (if applicable)
Emergency contact name
*
Emergency contact relationship
*
Emergency contact number
*
Do you have health insurance?
*
Due to certain risks inherent in handling animals, personal health insurance coverage is required to volunteer at the Parke-Vermillion County Humane Society.
No
Yes
Do you have any allergies?
*
No
Yes
If yes, please list.
Do you have any medical conditions you would like us to be aware of?
*
No
Yes
If yes, please describe:
Do you have reliable transportation?
No
Yes
Driver's License #.
What areas are you interested in?
Fundraising
Cat Care at PetSmart
Planning/Helping at Events
Animal Training/Socialization
Help at Shelter – general cleaning
Bathing/Grooming animals
Office/Secretarial
Walking Dogs
Grounds Keeping/Landscaping
Driving Animals to Vet Appointments, Adoption Events, etc.
Photographer
Volunteer Coordinator
Adoption Counselor
Being on a Committee
Legal Help
Communications
Correspondence
Doing Volunteer work at Home
other
Additional information:
Please explain what you hope to contibute as a volunteer?
*
Please explain what you hope to gain through you experience volunteering?
Please list any relevant animal care/volunteer experience.
How many hours are you willing to commit to as a volunteer?
Have you been convicted of, or plead no contest to, a felony in the past 7 years?
*
Conviction may not necessarily disqualify you from volunteering. We may conduct a background check, and if you do not provide complete and truthful information, you could be rejected or terminated.)
No
Yes
If yes, please explain:
Are you willing to undergo a background check?
No
Yes
Are you volunteering to fulfill a court ordered community service program?
No
Yes
Please provide 2 references, please include name, relationship, phone number and email address
I hereby release, indemnify and hold harmless the Parke-Vermillion County Humane Society, Inc. (PVCHS), their officers, directors, employees, successors, assigns, legal representatives, organizers, sponsors, volunteers and supervisors of all its activities, from any and all claims, causes of action and liability arising from or in any way connected with any volunteer activities in which I participate. I, further, understand that I am expressly assuming all risk, including but not limited to all risk of injury associated with my volunteer participation. I, further, grant permission to the Parke-Vermillion County Humane Society, Inc. to use, without cost, any photographs, videos or audios taken of me during any volunteer activity related to PVCHS for publicity purposes. I acknowledge that I have read this release and am voluntarily executing this release on the given date.
*
YES
NO
Please sign your name to finish this application after you verify all above information is correct.
*
Clear
