Friendship APL Community Service Application

Friendship APL Community Service Application

If you need to track volunteer hours for either court or an academic program, please use this form.
Candidate Name*

First NameLast Name
I am:*

10 - 15 years of age **must have parent or guardian on premises at all times**16- 17 years of age18 years of age or older
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
If you are under the age of 18, what is the name of your legal guardian? (If you are 10 -15 years of age, you CANNOT volunteer without a guardian present.)
Referral Information
How many hours do you need to complete?*
By what date do your hours need to be completed?*
I am completing hours for:*

CourtSchoolOther
If you are completing hours for court, please list the name of the court and your offense.
If you are completing hours for school, please list the name of the school.
Proof of my hours should be sent to what person?:*
This person is a:*

RefereeMagistrateJudgeParole OfficerTeacherLeader
Please provide a phone and fax number for this person.*
Health Information
Do you have any health problems that we should know about?
Are you allergic to any allergies or cleaning products?

Emergency Contact*

	Name	Phone Number	Relationship
Contact

Community Service hours are from 8:30am - 4:30pm. I am available to help on the following days:*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Participants must sign in and out at the clipboard on the front desk for each of their shifts.

Friendship APL only records the number of hours you have completed to date. It is the responsibility of the participant to track the number of hours they need to complete. Participants MUST notify staff members when verification of their hours needs to be sent to a specific agency. Please provide a few days notice when hours need to be sent, as not all staff members have the ability to provide verification of hours completed.
Community Service Guidelines
FRIENDSHIP APL DOES NOT PROVIDE COMMUNITY SERVICE HOURS TO ANY PERSON SENTENCED TO COMMUNITY SERVICE AS A RESULT OF AN OFFENSE OF CRUELTY AGAINST ANIMALS, A VIOLENT OFFENSE OR A SEXUAL OFFENSE.
I acknowledge the above statement.

Signature or Initials Clear
Friendship APL reserves the right to dismiss a community service worker due to any of the following behaviors:
- Refusal to do assigned tasks or non-completion of assigned tasks
- Failure to follow directions
- Quarreling with staff, volunteers or other Community Service workers
- Excessive free time or loitering
- Running, screaming, rough-housing or other disruptive behavior
- Theft or lying
- Destruction of materials or equipment
- Mistreatment of animals results in immediate dismissal. The court (or your parole officer) will be notified of your conduct.
I acknowledge the above statement.

Signature or Initials Clear
As a Friendship APL Community Service Worker, you agree to the following rules:
- Wear comfortable, non-revealing clothing while working. You must wear long pants or jeans and close-toed shoes. SANDALS AND FLIP-FLOPS ARE NOT PERMITTED.
- Report to the front desk and let them know you are present for Community Service. A staff member will find you a job. When your job is complete, please return to the front desk for another task.
- Perform all jobs assigned to you in a reasonable amount of time and return any equipment or supplies used during your shift to their original locations.
- You must follow the instructions of staff members or you will asked to complete your hours elsewhere.
- DO NOT bring family or friends to work with you. They will be sent home. (The only exception is if the Community Service Worker is between the ages of 10 and 15 years old and must be accompanied by a parent or guardian.)
- Do not use your cell phone while working.
- Do not enter Isolation or Treatment rooms unless assigned to do so by staff.
- Do not smoke anywhere except in designated smoking areas.
- You must sign out if you leave the premises for lunch.
- Injuries or illness of an animal or yourself must be reported to a staff member immediately.
- Please refer any questions about animals, the shelter or the adoption process to an actual staff member. Though we appreciate your assistance in the shelter, we want to ensure all information given to the public is accurate.
I acknowledge the above statement.

Signature or Initials Clear
COURT-ORDERED COMMUNITY SERVICE VOLUNTEERS ARE NOT PERMITTED TO INTERACT WITH THE ANIMALS. THE COMMUNITY SERVICE OPPORTUNITIES AVAILABLE TO THESE WORKERS ARE LIMITED TO CLEANING FROM 8:30AM AND 10:30AM OR SORTING DONATIONS/ PERFORMING SHELTER MAINTENANCE.
I acknowledge the above statement.

Signature or Initials Clear
Volunteer/ Release Waiver: The undersigned, as a Community Service Worker of the Friendship Animal Protective League, does hereby release the Friendship Animal Protective League, it's officers, trustees and employees from any and all liabilities, claims, demands, suits, actions, and causes of which actions may arise out of the undersigned's work as a Community Service worker for the Friendship Animal Protective League.

The undersigned further acknowledges that his/her work as a Community Service Worker may involve contact with animals which may bite or injure the undersigned.

The undersigned assumed the risk of any injuries incurred as a Community Service Worker with the Friendship Animal Protective League in executing this Waiver and Release.

The waiver/ release must be completed before any individual may become a Community Service Worker for the Friendship Animal Protective League.
Candidate Signature ( or Parent or Guardian Signature if under the age of 18)*

Clear
Should be Empty:

Friendship APL Community Service Application

Referral Information

Health Information

Community Service Guidelines