Emergency Only Volunteer Application
This is for emergencies only. You are volunteering to assist with emergencies and natural disasters and can be called at any time.
Full Legal Name (same as on your driver's license)
*
First Name
Last Name
Physical Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mailing Address: (if different than Physical address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number:
*
-
Area Code
Phone Number
Mobile Carrier:
*
AT&T, Verizon, T-Mobile, etc.
Do you prefer texts?
Yes
No
Home Number:
-
Area Code
Phone Number
Birth Date (required for travel)
/
Month
/
Day
Year
Date
Email:
*
example@example.com
Shirt size:
*
Small
Medium
Large
XL
XXL
XXXL
Do you work with any other rescue organizations?
*
Yes
No
If yes, who?
Service offering: (check all that apply)
*
Admin/Office Assistance
Animal Care & Feeding
Backyard (must be fenced)
Call Center/Dispatch
Covered Stalls
Domestic Pet Foster
Donating Equipment
Farm Animal Foster
Farrier
Feed Transport (car or suv)
Feed Transport (truck)
First Aid/CPR certified
Grooming
Lending Equipment
Pasture
Photographer
Rescuer (Certified Only)**
Storage (Food, Feed, Supplies, etc.)
Training/Obedience
Transport Domestic Pets
Transport Farm Animals with Trailer
Veterinarian
Videographer
Vet Tech
Other
If you listed other or equipment, please explain or describe:
Reference #1 (Name, phone # and relationship to self)
Reference #2 (Name, phone # and relationship to self)
**If applying as a Certified Rescuer, please list your certifications and training. Upload any documentation at the end.
Upload any documents or certificates:
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Pasture
You previously indicated you have pasture available, please answer the following to the best of your knowledge. We also require the pasture to be completely fenced and able to sustain the animals you list below.
Number of Acres you have available to hold farm animals:
*
2 to 4 acres
5 to 9 acres
10 to 14 acres
15 to 19 acres
20 to 24 acres
25 to 29 acres
30+ acres
Acreage is available to hold and feed animals temporarily.
Location of Pasture:
*
Area and Address or nearest cross streets (i.e. Panaewa, 1234 Railroad Ave)
Do you have an isolation area or the ability to separate your animals from incoming foster animals?
*
Yes
No
Other
Do you have the ability to contain and secure animals for a veterinarian to treat the incoming animals?
*
Yes
No
Other
Water available?
*
Yes
No
Other
Shelter available?
*
Yes
No
Other
Types of animals you are able to foster:
*
Alpaca
Cats
Chickens
Cows
Dogs
Donkeys
Ducks
Geese
Goats
Horses
Mules
Pigs
Rabbits
Sheep
Turkeys
Other
List the amount and type of animals you are able to support on your pasture.
*
Example: 20 cows, 2 donkeys, 10 geese.
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Transport
You previously indicated you are able to assist with the transport of farm animals with a trailer.
What size and type of trailer do you have?
*
You have a current and valid driver's license?
*
Yes
No
Is your vehicle and trailer insured?
*
Yes, personal insurance
Yes, commercial insurance
No
Other
Skill level of driving and maneuvering your trailer?
*
Novice
Intermediate
Advanced
Expert
How much time would it take you to arrive on location from the time you are contacted? Use current evacuation area as the destination. Allow for time to get trailer and arrive at destination. List time in quarters. (i.e. Laupahoehoe to Pahoa - 2.25 hours)
*
Home to Evacuation Area
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In case of emergency, who should we contact? Provide name(s) and phone numbers.
*
Are you Hawaiian or Part-Hawaiian? (For statistics only)
*
Yes
No
Agreement:
This Volunteer Agreement (“Agreement”) is entered into as of the date set forth below by HAWAIʻI ANIMAL KULEANA ALLIANCE (HAKA). WHEREAS, the Volunteer has voluntarily contacted HAKA and has expressed an interest in working during emergencies and disasters with Animals in the care and/or custody of HAKA. In consideration of HAKA’s agreement to allow the Volunteer to view and/or interact with such Animals, the Volunteer hereby, for his/her heirs, his/her personal representatives, and him/herself represent and warrant as follows: 1. The Volunteer is fully aware of the risks that Animals pose and have elected to view and/or interact with one or more Animals in the care of HAKA voluntarily. The Volunteer knowingly assumes all risks that exposure to Animals may pose, including but not limited to serious bodily injury and/or death. 2. THE VOLUNTEER HEREBY WAIVES, RELEASES DISCHARGES, HOLD HARMLESS, AND PROMISES TO INDEMNIFY AND NOT TO BRING SUIT AGAINST HAKA, its directors, officers, Volunteers, staff, and all other agents, and attorney for any of the referenced parties and any other parties acting for or on behalf of the referenced partied from an and all rights and claims which the Volunteer has or which may hereafter accrue to the Volunteer and from any and all damages which may be sustained by the Volunteer directly or indirectly in connection with, or arising out of, the Volunteer’s exposure to such Animals.
By typing your name here, you are agreeing to the above liability waiver and certifying you are age 18 or older.
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