Volunteer Forms

ACTS - Assistance Canine Training Services
2928 East Conway Road
Center Conway, NH 03813
603-383-2073

IMPORTANT INSTRUCTIONS: Please read carefully

Please use your TAB key to move on to the next entry box.

You must fill out this entire form in one session. If you leave your form will NOT be saved.

Date*

Date

Name*

First NameLast Name

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Shipping Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Email*

example@example.com

Secondary Address/Home Address for College Students

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

ACTS Emergency Contact Information

Emergency Contact #1 Name*

Relationship*

Phone Number*

Secondary Phone Number

Emergency Contact #2 Name*

Relationship*

Phone Number*

Secondary Phone Number

ACTS Acknowledgement & Receipt of Volunteer Handbook

I have received a digital or hard copy of the ACTS Volunteer Handbook*

YesNo

ACTS Code of Conduct Conflict of Interest

Code of Conduct and Conflict of Interest Policy (as outlined in the Volunteer Handbook)

All volunteers shall meet the following standards of conduct.

No volunteer shall:

Publicly use an affiliation with the organization with the promotion of partisan politics, religious matters or position on any issue.
Disclose or use any confidential information that is available solely as a result of the volunteer's affiliation with the organization to any person not authorized to receive such information or use to the disadvantage of the organization any such confidential information without the express authorization of the Chairman of the Board of the organization.
Knowingly take any action or make any statement intended to influence the conduct of the organization in an way as to confer any financial benefit to any person, corporation, or entity in which the individual has significant interest or affiliation.
Operate or act in a manner that is contrary to the best interest of the organization.
Operate or act in a manner that creates a conflict of interest with the interests of the organization and any other organization in which the individual has a personal, business, or financial interest. The individual shall disclose such conflict of interest to the Board

I have read and understand the Code of Conduct & Conflict of Interest Policy and agree to comply with it. I affirm that except as listed below, I have no personal, business, or financial interest with any organizations that conflicts or appears to conflict with the best interest of ACTS At any time during my term of my volunteer status with ACTS, should an actual or potential conflict of interest arise between my personal, business, or financial interest and the interest of ACTS, I agree to promptly disclose the actual or potential conflict to a Board member and until ACTS approves action to mitigate or otherwise resolve the conflict, I will refrain from participating in any discussions, deliberations or voting related to the conflict of interest.*

YesNo

Confidenciality Agreement

As a volunteer for Assistance Canine Training Services (ACTS), I understand that I will be given access to the Organization’s facilities, records, and information related to it’s operation. Included in such, but not limited to are: client and volunteer files, general files, electronic files, emails, other organizational documents, proprietary information, and contextual knowledge gained through the volunteering experience/process, hereafter referred to as “documents”.

I also understand that I may be expected in the course of my volunteering to work with and/or produce documents or products relating to the Organizations’ operation.

I agree that I will not, during or after my volunteer time, discuss with or disclose (other than in performing my duties as an employee or volunteer of the Organization) any documents or knowledge I have obtained or developed as an employee or volunteer concerning the Organization’s operation, excluding that which is generally known to the public.

I also agree that all documents prepared by me or in conjunction with others in the course of my employment or volunteering shall be the property of the Organization, and that I will not make or permit anyone else to make any copy, abstract or summary thereof. Upon termination of my employment or end of my volunteering I will return to the Organization all such documents.

I agree to keep confidential any information regarding the health status of any client and only utilize this information as needed. I will not share this information other than in the completion of my duties for ACTS.

I further represent that I am under no obligation to any person or firm that is in any way inconsistent with this agreement, or that imposes any restrictions on my activities on behalf of the Organization.

I have read and understand the above confidenciality agreement.*

yesno

ACTS Volunteer Release Form

I understand that working with dogs is not without risk to me, my pets, my property, members of my family, friends of the family including but not limited to guests in my home, and persons of all ages with whom I might come in contact with regardless of their relationship with me. There may be incidents that are beyond the control of ACTS, and I assume this risk as my own, solely. I release and agree to hold harmless ACTS, their paid employees, volunteer trainers and supervisors, any other supervisory volunteers of ACTS, the Board of Directors, and all the other volunteers, (henceforth referred to as “agents of ACTS”), from any fault or liability of any nature, for injury or damage which I or anyone with or around me, or any of my pets/animals or any other animals with or around me, may suffer. I agree to carry personal auto liability insurance on all personal vehicles used to transport ACTS dogs and release ACTS from any liability for my personal vehicle . Some of the dogs in which I will/may come in contact with may be difficult to control or through the nature of working with animals, may be the cause of injury or damage, even when handled with the greatest amount of care. I understand that being exposed to dogs involves potential risk and that any of my personal dogs/pets could be hurt, or could contract an illness, through no fault of ACTS and therefore do not hold the agents of ACTS responsible. I understand that it is my responsibility to keep my animals and any animals that the ACTS puppy in training may be exposed to, safe and up to date on his/her/their vaccinations. I understand that the action of ANY other agents of ACTS that may cause injury, harm or damage to me, my pets and members of my family, guests, any individuals I may come in contact with, or property, represent a clear risk of volunteering, and that I assume this risk as my own, solely and hold no agents of ACTS responsible for any injury or harm. I request Assistance Canine Training Services (ACTS) to keep this information on file and use as a waiver for any and all classes, field trips, training gatherings, social gatherings, or for any time I am working as a volunteer for ACTS with or without a dog. I have read and understand the release.*

yesno

ACTS Photo Release

Please choose one:*

I grant permission to ACTS to use photographs or video of me in their promotional materials and social mediaI DO NOT grant permission to ACTS to use photographs or video of me.

Social Media

ACTS is interested in promoting our program through social media. We would like to be able to offer our followers updates on dogs in training. Additionally, ACTS is always looking for appropriate photography to promote the program through print and other media.

Please choose one:*

Yes I would like to give ACTS permission to use photos I post on my own social media page/s for their promotional use.Yes I would like to give ACTS permission to use photos I post on my own social media, for their promotional use, however I do prefer that I am contacted before any photos are used.No I would prefer not to give ACTS permission to use photos I post on my own social media.

If you have agreed to allow ACTS to share from your social media, please provide your Social Media Accounts:

Facebook Account:

Instagram Account:

LinkedIn:

Other:

Confirmation of Personal Auto Insurance Coverage

ACTS requires volunteers to carry personal auto liability insurance on all personal vehicles that transport dogs. Do you carry personal auto liability insurance?*

YesNo

Telling Tails Facility Release

I understand that attendance of dog training class and dog play group of any kind is not without risk to me, my dog, my property, members of my family, and guests who may attend. Some of the other dogs to which I (we) will be exposed may be difficult to control and may be the cause of injury, even when handled with the greatest amount of care. There may be incidents that are beyond the control of anyone present, and I assume this risk as my own, solely. I also understand that by being exposed to other dogs involves a potential risk and that my dog could contract an illness, through no fault of Telling Tails, and that it is my responsibility to keep my dog up to date on his/her vaccinations. I hereby release and agree to hold harmless, Telling Tails Training Center, the instructor, class assistants, the business owner, the property owner, and all other attendees, from any fault or liability of any nature, for injury or damage which I (we) or my dog may suffer. It is also understood that the action of ANY dog present may cause injury, harm or damage to me, my dog and members of my family, guests, or property and I assume this risk as my own, solely. I expressly assume the risk of any harm that is inflicted upon me, my dog, or any guest of mine whatsoever, while on the training facility property or surrounding property or in a class situation off the property.

YesNo

I acknowledge that by submitting my name and signing below, that all the above information is accurate.

Name*

First NameLast Name

Please Sign and Submit*

Required Volunteer Forms