VOLUNTEER APPLICATION

VOLUNTEER APPLICATION
Name*

First NameLast Name
Birthday*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell phone number*
Please enter a valid phone number.
Home phone number
Please enter a valid phone number.
Work phone number
Please enter a valid phone number.
Where are you most interested in helping?*

ShelterSAPA Store & Adoption Center (cleaning/feeding cats)SAPA Store & Adoption Center (Sat/Sun Customer Service)Wherever I'm most neededOther
Any special skills you would like to donate/use to help the animals & St. Animal Pet Adoptions?*
What experience do you have with dogs/cats?*
Have you volunteered at a shelter before? If so, where? What did you do there?*
How did you hear about us?*
What days and hours would you be available to volunteer?*
Name and phone number of your personal reference # 1:
Name and phone number of your personal reference # 2:
ACCIDENT WAIVER AND RELEASE OF LIABILITY - I will be working as a volunteer with the City of St. Ann Animal Shelter / The SAPA Store & Adoption Center. I understand that I will have direct physical contact with the animals at the shelter, The SAPA Store & Adoption Center (SAPA), or in my home as a foster parent and that contact carries inherent risks of injury and damage to me personally; I will obey any instructions given to me by official staff of the City of St. Ann/SAPA and will carefully read all messages pertaining to each animal with which I have contact. I acknowledge that my presence at the animal shelter, SAPA or in my home as a foster parent carries the potential for accidental injury and/or property loss. The risks include, but are not limited to, those caused by the condition of the facility, injury or illness as the result of general or direct contact with animals, the actions of other people and/or vehicles. I hereby assume all risks of acting as a volunteer. I acknowledge that this Accident Waiver and Release of Liability form will be used by the City of St. Ann, its employees, volunteers, representatives, agents and others working in behalf of the City of St. Ann, and that it will govern my actions and responsibilities. In consideration of my participation as a volunteer, I hereby take actions for myself, my executors, administrators, heirs, next of kin, successors and assigns to: A. Waive, release and discharge from any and all liability for my death, disability, personal injury, property damage, property theft, or actions of any kinds which may hereafter accrue to me, including as to my traveling to and from this activity, the following entities or persons: City of St. Ann, its employees, volunteers, representatives, agents, Mayor, Board of Aldermen, veterinarians and others working or acting on behalf of the City of St. Ann, and B. To the fullest extent permitted by law, hold harmless the entities or persons mentioned above from any and all liabilities or claims made by other individuals or entities as a result of or relating to my participation as a volunteer. I hereby consent to receive medical treatment of which may be deemed advisable in the event of injury, accident, and/or illness during my participation as a volunteer. I further agree that I will defend, indemnify and hold harmless the City of St. Ann, its officers, directors, Mayor, Board of Aldermen, members and agents, employees, volunteers, and veterinarians or any of them against all claims, demands and causes of action or other proceeding brought by or prosecuted for my benefit contrary to this release extended to all claims of every kind and nature whatsoever whether known or unknown and expressly waive any benefits. I hereby certify that I have read this document and understand and agree to its content.
SIGNED:*

First NameLast Name
If you are under 17 years of age your parent/gaurdian's signature is required as well.
PARENT/GAURDIAN SIGNATURE:

First NameLast Name
Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty: