RPC Volunteer Application and Liability Waiver

RESPONSIBLE PET CARE OF OXFORD HILLS, INC.
9 Swallow Rd, South Paris, ME 04281
207-743-8679

Your Name*

Address*

Address

Street Address Line 2

CityState

Zip

Phone*

Cell Phone

Please enter a valid phone number.

Email*

example@example.com

Date of birth

Have you ever been convicted of a felony? Note: No applicant will be denied a volunteer opportunity solely on the grounds of a conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.*

YesNo

Work Status:

I have a full time jobI have a part time jobI do not work at this time

I can realistically help number hours each week, during these days and times best days and times

Yes, I am covered by health insurance with insurance company .

No, I do not have health insurance coverage. If you do not have coverage, you understand that expenses from possible injury will be paid by you, not Responsible Pet Care of Oxford Hills. initials

Have you ever been investigated by Animal Control for any reason?*

Have you worked/volunteered with a humane society, shelter or in animal care? If yes, please list organization.*

Is your involvement with the organization(s) listed above current?

I also understand that the behavior of domestic animals is at times unpredictable and that some domestic animals are capable of inflicting property damage, serious personal injury, and even death. I am well aware of the risks of handling domestic animals, and with such understanding, I hereby waive, release, indemnify, hold harmless and forever discharge Responsible Pet Care, employees, agents and trainers from any and all claims (whether present or future) arising out of my participation in the Volunteer Program.

Signature*

Date*

Date

Witness*

Witness Signature*

Date*

Date

Rank your areas of interest

	Very Interested	Somewhat Interested	Not Interested
Dog Walker - daytime or evening (must be 21 or older)
Housekeeping/Kitchen
Cleaning cat/small animal areas
Maintenance
Education - developing programs, youth
Events - planning, setting up, advertising, etc.
Office/Greeting visitors, phone calls, screening applicants
Animal Transportation to/from vet appointments (must be 21 or older)
Foster Family
Pawsibilities Thrift Store
Marketing, newsletter, publications
Other - shelter display, errands
Cleaning dog areas, poop patrol in play yards, prepping dog meals (must be 21 or older)

We reserve the right to contact those listed on your application.

RESPONSIBLE PET CARE OF OXFORD HILLS, INC.

VOLUNTEER LIABILITY RELEASE FORM

Volunteers are an important part of Responsible Pet Care and we welcome those who wish to participate in our programs. You must have an application on file and have attended our training class. Anyone that will be volunteering must willingly sign this form.

Print Name*

Date*

Date

I certify that I am over 18 years of age.

Initial*

Children under the age of 18 must be have a guardian with them at all times while volunteering at the shelter.

Guardian's Name

Relationship to minor

Address

Street Address Line 2

CityState

Zip

Phone (day)

Phone (evening)

Cell

Email address

example@example.com

MEDICAL RELEASE:
I certify that I am medically and physically able to perform the tasks that will be assigned to me without limitations including, but not limited to, walking dogs who may jump or pull, lifting, bending and more. initials
In case of emergency, I authorize Responsible Pet Care to arrange emergency medical treatment after attempting to notify the contacts listed below. List 2 personal contacts below.

Advisory: You are strongly urged to have a current tetanus vaccination to protect yourself should you be cut, scratched or otherwise injured in such a way that tetanus infection could threaten your health. I have read this and have been advised.

Initials

Name*

Tel #*

Relationship*

Name*

Tel #*

Relationship*

RELEASE OF LIABILITY

I fully understand that as a part of my volunteer work at Responsible Pet Care I will come in contact with animals either by direct handling or assisting in their care. Further, I understand that working with animals carries a risk of injury and that it is possible that - may be bitten, scratched, and/or otherwise injured. I also understand that I may be exposed to canine and/or feline illness and disease and that it is also possible that I could indirectly expose my own pets to such illness and disease. My signature to this Volunteer Liability Release attests to my intent to hold harmless and release from all liability Responsible Pet Care, their agents and assigns from all acts which are related to my performance of any and all volunteer duties.

By submitting this application, you consent to a comprehensive background check, which may include criminal, education, and employment history. This information will be used solely for the purpose of evaluating your suitability for the position. Any discrepancies or concerns that arise from the background check may result in the withdrawal of your application or termination of your employment/volunteer status.

Signature of Volunteer*

(Guardian signature if volunteer is under the age of 18 years)

Thank you for your interest in volunteering. We look forward to working with you!