Volunteer Application | Spfld Humane Society

Date

First name

Last name

Birthday

Mailing Address

Town

State

Zip Code

Physical Address (if different from mailing address)

Cell Phone

Home Phone

Email

Emergency Contact Name and Contact Information

What volunteer options are you most interested in? (check all that apply)

Do you have experience volunteering? If so, where?

Do you have experience working with animals, either personally or professionally? If so, please explain briefly.

Reason for volunteering:

Court mandated

School community service hours

Fun

Other

Have you ever been convicted of a felony? If so, please explain.

Some of our volunteer opportunities may bring our pets into contact with yours. Please list your vet's name and number so we may contact them. Note: we will only contract your vet if needed for certain volunteer opportunities (foster care, rent-a-rover)

I understand I will need to contact my veterinarian to give permission to speak with Springfield Humane Scoiety

Please list ALL current pets in your home (include name, species, breed, age and spay/neuter status)

As a prospective volunteer of Springfield Humane Society, please check this and all following boxes, agreeing to the rules of volunteering

I will not attempt to train any animal without first discussing said training with shelter staff and/or Executive Director so as to ensure that all animals are being trained with positive reinforcement, and in the same manner.

I will hold absolutely confidential all that I obtain, directly or indirectly, concerning clients, animals or staff. I agree not to seek confidential information from a client. I understand that an intentional or unintentional violation of confidentiality may result in termination by the SHS, and/or possible legal actions by others, (i.e., clients, customers)

I will not donate any services to the SHS without contemplation of compensation or future employment

I will not interface with members of the media unless otherwise directed by Executive Director.

I will seek assistance from a staff member whenever I have a question, or am faced with a difficult situation.

I will communicate any job related problems, concerns, differences of opinions, conflicts, or suggestions only to the Shelter Manager or Executive Director.

I will notify the Shelter Manager or Executive Director when I am unable to work as scheduled.

I will notify the Executive Director if I choose to discontinue my volunteer service with the SHS.

I allow SHS to use any images/pictures/videos/stories of me in my work as a volunteer on public media

I have been advised that the activity of working shelter animals is hazardous and involves contact with animals that at times may be unpredictable. As such Springfield Humane Society, Inc. cannot be held liable for injuries or accidents that may occur as a result of working with animals

I agree that injuries, loss or damage to personal property, and death may occur as a result of Volunteer's participation at the shelter. The Volunteer agrees that Springfield Humane Society Inc. shall not be held responsible or liable for any personal injury or other injury.

I agree that myself or my heirs executors and administrators hold harmless each Indemnitee against any and all manner of legal actions, such as suits, debts, claims, or liability of any kind incurred while I participate at the shelter or fundraising events.

I fully, completely and unconditionally waives and release each Indemnities from all rights, liabilities, duties, claims, charges, demands, actions, damages, costs, attorney fees, or expenses of any kind that Volunteers may have now or in the future against Springfield Humane Society, Inc. or any Indemnitee relating to the participation at the shelter.

Please print name below, agreeing to the above (parent/guardian if minor)