Print, fill out form and mail to: Animal Aid Society, Inc., Volunteer Coordinator,
80 Butler Farm Road, Hampton, VA 23666 - A Volunteer Coordinator will contact you.

ANIMAL AID SOCIETY, INC.-VOLUNTEER WAIVER AND RELEASE

PLEASE READ AND COMPLETE THIS SECTION FIRST:

Have you ever been convicted of Animal Abuse? Yes____________No ____________

“ACTIVE VOLUNTEER” is a person who makes a commitment of volunteering 100 hours or more per year doing one or more of the following activities. Members of the active membership class who have acquired at least 100 hours by working on a shift over the course of one calendar year shall be eligible to serve in any office or position in the corporation. Active membership is to be verified by the Board of Directors by the last day of December each year.

I want to be an active volunteer and I am willing to do one or more of the following activities:

FOR PERSONS 18 AND OLDER:

1. Working a regularly scheduled shift at the shelter (4 hours credit per shift). I will be able to work the following day(s)
__________________________________________________

2. Working a regularly scheduled shift at Walmart/other locations (5 hour credit per shift). I will be able to work on the following day(s)__________________________________________________

3. Shelter maintenance is on Thursdays and Sundays weather permitting. Approximate time is 12 noon to 4 pm. (Hours worked
plus 1 hour credit). I will be available to work on Thursday: Yes____No____ Sundays: Yes____No_____

4.4. Fund raising, ongoing and special projects, etc. (hours worked). I am willing to participate in these functions: Yes____ No____

5. Please indicate your talents, hobbies, or special interests: Carpentry ________ Painting _________ Computer Work _________Writing ______ Gardening _______ Other, (Arts/Crafts, etc.) _____________________________________________________ .

TO BE LISTED ON THE ACTIVE VOLUNTEER ROSTER, THE ABOVE COMMITMENTS MUST EQUAL 100 HOURS!

I____________________________, realize that volunteering with the Animal Aid Society may expose me to some risks. I acknowledge that I will be working with dogs who, for the most part, are strays and that some of them may have been abused and may have the tendency to bite or harm me! With this in mind, I hereby freely volunteer to work and assist in taking care of and providing for the dogs and other animals housed by the Animal Aid Society. To enhance my safety and the safety of the animals, I hereby agree to abide by the rules and policies of the Society and its duly elected Board of Directors. If a volunteer breaches the signed contract regarding our special needs dogs or any other instruction that is for the safety of the dogs or other volunteers they will be required to leave the AAS premises and have their volunteer status revoked.

In addition for sufficient consideration, the receipt of which is hereby acknowledged, I hereby waive my right to proceed against the Animal Aid Society should I be harmed by any dogs and other housed animals or sustain any type of injury of whatever nature working with the Animal Aid Society.

Executed this_________day of______________, 20___________

Printed Name:_______________________________Signature:____________________________
Address:________________________________City:___________________________
State:___________________________Zip:___________________
Work Phone#:________________Home Phone#:_______________Cell Phone#:___________
Witness:__________________________________________________

If you would like to be notified of shelter events by e-mail, please list your e-mail address:
___________________________________________________

PLEASE INDICATE HOW YOU LEARNED OF THE ANIMAL AID SOCIETY:__________________________
IF THIS IS COMMUNITY SERVICE what is it related to: SCHOOL__________WORK__________CHURCH__________
SCOUTS__________COURT__________OTHER_____________________________________________

FOR ALL VOLUNTEERS: DATE OF LAST TETANUS SHOT:__________________(Good for 10 years)
DO YOU HAVE ANY HEALTH ISSUES?_____________________________________________
HIGH/LOW BLOOD PRESSURE:________HIGH/LOW BLOOD PRESSURE:______PREGNANT:__________
HISTORY OF SEIZURES:___________SOME HEALTH ISSUES REQUIRE A DOCTOR'S CONSENT BEFORE VOLUNTEERING AT THE SHELTER.


EMERGENCY CONTACT NAME AND PHONE NUMBER _______________________________________________________



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