Name
First Name
Last Name
D.O.B./Age
*Must be 16 or older to volunteer.
Street Address
City:
State:
Zip:
Home Phone:
Cell phone:
Email Address:
Employer/Job Title:
Allergies or physical restrictions:
Date of last Tetanus shot:
A Tetanus shot is required within the past 5 years.
Date of last TB Test (PPD) (Not required to volunteer)
Test is required to work with the primates.
How did you hear about us?
Why do you want to volunteer at Safe Haven & Educational Adventures?
Have you volunteered with another organization?
Yes
No
If so, what is the name of that organization:
What was your favorite thing about volunteering for this organization? What was your least favorite?
Please list any pets you currently own (or have owned in the past).
Animal Experience: (check all that apply)
Veterinary Hospital
Exotic Animals
Boarding Facility
Foster Home
Shelter Work
Training/Obedience
Pet Sitting
Farm Animals
Other
Please comment on your experience with the above:
If you listed other, please explain:
Other Experience, Special Skills, Strengths, Talents: (check all that apply)
Computers
Crafts
Working w/children
Woodwork/Carpentry
Painting
Photography
Writing
Fund-raising
Public Speaking
Horticulture / Gardening
Grant Writing
Other
If you would like to comment more on your experience with the above, please do so here:
If you listed other, please explain:
Volunteer Work Preferences: (check all that apply)
Animal Care
Educational Programs
Special Events
Photography
Clerical/Office
Computer/Website
Grant Devolopment
Community Outreach
Writing (for newsletter or other media)
Other
When are you available to volunteer? (check all that apply)
Weekdays
Weekends
Reference #1 (Name, phone # and relationship to self)
Reference #2 (Name, phone # and relationship to self)
Reference #3 (Name, phone # and relationship to self)
Any additional comments:
In case of emergency, who should we contact? (name and phone #)
VOLUNTEER AGREEMENT GENERAL RELEASE AND WAIVER
In consideration of the opportunity to volunteer with Safe Haven & Educational Adventures, Inc., I agree to the following: 1. I will abide by the mission, rules,regulations, policies and programs of Safe haven while I am a volunteer. 2. I recognize that while performing tasks,including handling animals, for Safe Haven, there exists a risk of injury as well as risk of personal property loss or damage. I assume the risk of all injuries or property damage in connection with my volunteer work for Safe Haven. 3. I agree that Safe Haven 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 Safe Haven. 4. I understand and agree that public relations are an important part of volunteering at Safe Haven, and I will allow Safe Haven to use any photographs, images taken of me in the Safe Haven’s public relations and marketing efforts. I acknowledge that I have read and fully understand the terms and conditions of the foregoing Volunteer Agreement/Waiver and Release Form, and I agree that I will comply with the same.
By writing your name here, you are agreeing to the above liability waiver.
By writing your name here, you are stating that you are the parent/guardian of the above applicant and you grant your permission for them to volunteer with Safe Haven & Educational Adventures, Inc.
*Parent or guardian must sign if applicant is under age 18.
Anything else you would like to say, please note it here:
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