Twin County Humane Society Volunteer Application

First Name*

Last Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

Primary Phone*

Area CodePhone Number

Additional Phone

Area CodePhone Number

Do you have experience working with animals?

YesNo

Please describe:

Describe any current or previous volunteer work you have done:

Please check the volunteer opportunities you would like to participate in:

Do you have a valid driver's license?

YesNo

What types of pets do you have in your household (check all that apply)?

CatsDogsOther

Please check the animals you are comfortable handling:

Have you ever been charged or convicted of animal cruelty, abuse, or neglect?

YesNo

I fully and forever release, discharge, acquit, and exonerate TCHS, its volunteers, affiliates, and all others acting on its behalf, from any and all claims, actions, causes of action, remedies and complaints of any kind which I have or may in the future have, whether known or unknown, arising out of or relating to the animals or my volunteer work for TCHS, including specifically all claims for personal injury, wrongful death, property damage and all claims resulting from any injury inflicted by animals.

I recognize and accept all risks associated with unpredictable animal behavior on behalf of me or any minor of whom I am Guardian. I specifically assume all risks arising out of or relating to the care and handling of the animals. I recognize that TCHS and/or its agents, volunteers, or affiliates make no representations whatsoever as to the past history of the animals and whether or not they are safe animals.

I agree to defend, indemnify and hold harmless TCHS from any and all claims and costs, including attorney fees, arising out of or relating to the animals.

Volunteer signature: Entering my name indicates my agreement to the terms and conditions above. *

Date*

Date

Please allow 48 hours for a reply to your application submission.