Parent's Name: *

Parent's Address: *

City: *

State: *

Zip Code:

Phone (day):

Phone (evening):

Employer:

Email address:

Why Would you like to be a volunteer with our rescue group?: *

Please check each type of volunteer work you are interested in doing: Transport
Coordinating Events
Home Visit Checks
Blog Writing
Foster Caregiver
Assist at events
Application screening
Web design
Fundraising
Telephone Calls
Newsletter writing
Other (Please explain)
*

Please provide specific information for any areas you checked above: *

Do you have any experience or training in any of the following areas?: Dog Training
Animal Rescue
Grooming
Writing
Fundraising
Other (Please explain)
*

Please provide specific information for any areas you checked above: *

What do you do for a living/what specific talents do you possess that you think would benefit H.E.A.L, Inc? *

Have you ever volunteered with another rescue group or with an animal related facility/shelter? Yes
No
*

If yes, please list the name and contact information for each group and what is/was your involvement?:

Do you hold any animal related organizational memberships or certifications? If so, please name them:

Would you be willing to place and maintain one or more donation canisters at local businesses to help with fundraising?: Yes
No
*

If so, how many?

Do you presently own a dog or cat?: Yes
No
*

If yes, please list Name, Breed, Age, Sex, Spay/Neuter status, and where obtained:

If you do not currently own a dog or cat, have you owned dogs or cats in the past?:

If yes, please describe them and what happened to them:

Name of Clinic/Veterinarian:

Address:

City:

State:

Phone:

What days are you available to volunteer?: Monday Tuesday Wednesday Thursday Friday Saturday Sunday *

What hours work best for you and on what days? *

I (or my child if applicant is under 21) have/has the following allergies (food, animal, medical, etc.): *

I (or my child if applicant is under 21) have/has the following medical conditions (diabetes, heart condition, seizures, etc.): *

In case of emergency, I authorize H.E.A.L, Inc. to arrange for emergency medical treatment (911) after attempting to notify the contacts listed below. List 2 personal or professional contacts below: *

Signature (PARENTS’ SIGNATURE IF UNDER 21):

I agree to allow pictures of myself (or my child, if applicant is under 21) to be used, without compensation, for the purpose of promotion and publicity related to H.E.A.L, Inc. *

You are strongly urged to have a current tetanus vaccination to protect yourself in case you are cut, scratched or otherwise injured in such a way that a tetanus infection could harm your health:

Initial (PARENTS’ INITIAL IF UNDER 21): *

You are required to discuss privately with the Volunteer Coordinator any physical conditions you may have, or medications you may be taking affecting your blood clotting function or your immune system. This includes conditions such as, but not limited to, taking blood thinners, aspirin therapy, any autoimmune diseases, HIV, Hepatitis, chemotherapy, or immune system suppressants.  A release from your physician may be required in order to best protect you from injury.

Initial (PARENTS’ INITIAL IF UNDER 21): *

Volunteer Agreement

In consideration of this opportunity to volunteer with H.E.A.L, Inc., 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 H.E.A.L, Inc. while I am a volunteer.
2. If I stop being a volunteer for H.E.A.L, Inc. for any reason or upon the Rescue’s request at any time, I will promptly return all of the Rescue’s supplies, equipment, records, moneys, 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 the Rescue.   H.E.A.L, Inc.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 the Rescue.   I hereby indemnify, defend and hold the Rescue 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 the Rescue, or my breach of Rescue’s rules, regulations, policies and programs.
4. I understand and agree that the Rescue 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 the Rescue, me, and the Rescue’s and my respective heirs, successors, assigns, executors, and personal representatives.

In consideration of H.E.A.L, Inc. offering this volunteer opportunity, I/We agree to the following, intending to be legally bound:

1. My/our child(ren), or child(ren) under my/our guardianship, has enough experiance with dogs and/or cats and is mature enough to volunteer with the Rescue and to participate in activites with dogs/puppies of all sizes, and/or cats and kittens. Yes
No

2. Whenever my/our child(ren), or a child(ren) under my/our legal guardianship, participate(s) in the Rescue's activies, I/We hereby release, and agree to indemnify, defend and hold harmless the Rescue, itsdirectors, officers, employees, agents, and volunteers, and its and their heirs, successors, assigns, and personal representatives, from and against liability for any injuries, damages, liabilities, losses, judgments, costs or expenses whatsoever (the “Losses”), which such child(ren) or any pet or other person might suffer or sustain. Provide parents' signature understanding the terms stated in line 2:

3. I acknowledge that there are risks that the child(ren) could be bitten, scratched, injured or frightened by the dog/puppies and/or the cats/kittens and I/we assume such risks. Yes
No

4. I understand and agree that the Rescue may refuse volunteer applications for any reason: Yes
No

5. I have accurately and truthfully completed this Permission and Release Form. Yes
No

6. This Permission and Release Form is binding upon me, my spouse, partner, and my and his or her respective heirs, successors, assigns, executors, and personal representatives: Agree
Disagree 2

Sign Name:

Sign Name:

Childs Signature:

Parent Signature: