PLEASE READ AND COMPLETE THIS SECTION FIRST: Have you ever been convicted of Animal Abuse? Yes____________No ____________ "ACTIVE VOLUNTEER" is a person (family) who makes a commitment of volunteering 100 hours or more per year doing one or more of the following activities. To run for the Board of Directors and vote in elections for the Board, you must complete 100 hoursof service in the prior calendar 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. 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: Arts/Crafts__________________Carpentry_____________Computer Work_____________Needlework/Sewing____________Writing____________Gardening_____________Painting__________ Pet Pal_______Other____________________Dog Walking_______(Children under the age of15 must be accompanied by a parent/guardian/or licensed driver for the duration of the visit to the shelter). 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. 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 _______________________________________________________ |