THT Volunteer Application & Agreement

The Heroic Tail Dog Rescue

Volunteer Application, Agreement & Liability Waiver
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email*
example@example.com
Occupation/Job Title*
Current Employer*
May we contact them for reference?*

YesNo
If yes, please provide name of contact:
Employer Phone Number
Please enter a valid phone number.
Military*

Active DutyVeteranNo
Allergies or physical restrictions*
How did you hear about The Heroic Tail Dog Rescue?*
Why do you want to volunteer with The Heroic Tail Dog Rescue?*
Do you work with any other rescue organizations?*

YesNo
If yes, please provide contact information for that organization including name and phone number:
Have you ever been dismissed from a volunteer program?*

YesNo
If yes, please provide the reason, as well as the agency, company or department:
Animal Experience (check all that apply):*

Veterinary HospitalBoarding FacilityFoster HomeDog GroomingShelter WorkDog TrainingPet Sitting/Boarding
Any additional comments on the above or additional experience:
Other Experience, Special Skills, Strengths, Talents, etc. (check all that apply):*

ComputersGraphic ArtsCarpentryPaintingPhotographyWritingSecretarialFundraisingPublic Speaking
Any additional comments on the above or additional experience:
Volunteer Work Preferences (check all that apply):*

Kennel CleaningDog TransportDog WalkingClerical/OfficeFoster Care (please fill out a foster application)Computer/Website/Social MediaSpecial EventsEducational ProgramsCommunity OutreachOther
If you selected "other", please explain:

Availability*

Rows	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
AM
PM

Would you be willing to volunteer of the shelter premises?*

YesNo
References
Reference #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Reference #2*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Reference #3*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Emergency Contact
Name*

First NameLast Name
Relationship*
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Agreement
Thank you for your interest in volunteering for The Heroic Tail Rescue (THT). Your time and effort will greatly assist in keeping our dogs healthy and happy and increase their chances of finding a loving forever home. The following is not only to protect and inform the potential volunteer, but also to protect our dogs and their lives. Please read the following thoroughly and be sure you understand each paragraph.

Initial next to each bullet and fill out the rest of the form accordingly. Thank you for your time.
1. I acknowledge and understand that as a volunteer of THT I am not covered by worker’s compensation or any other insurance policy through THT for any injuries I may sustain through volunteer activities. I understand that I am responsible, if I desire to do so, for obtaining health insurance coverage through an independent health insurance company.
Initials*
2. I fully understand that as a part of my work for THT I will come into contact with animals either by directly handling them, fostering, or through assisting in their care and adoption. Further, I understand that working with animals carries a risk of injury, and it is possible that I may be bitten, scratched, or otherwise injured.
Initials*
3. I further agree to indemnify and save and hold harmless THT, their officers, agents, successors, volunteers, and employees from and for any and all claims resulting from injuries, liabilities, costs, expenses, suits or any damages or loss sustained by me and arising out of, connected with, or in any way associated with THT. FOSTER ALSO AGREES TO WAIVE ANY AND ALL RIGHTS OF SUBROGATION AND DEFENSE AGAINST THE HEROIC TAIL RESCUE.
Initials*
4. The Heroic Tail feels it is important for all volunteers to be current on their tetanus vaccination if they will be handling animals as a volunteer. If a volunteer has questions about the tetanus vaccination, they are encouraged to ask their physician, at the volunteer’s own expense, to decide whether or not to be vaccinated against tetanus.
Initials*
5. I will not rescue any stray or shelter animal in the name of THT without prior authorization from a director, officer, or authorized employee of the organization.
Initials*
6. I agree that any animal rescued by THT is solely owned by and is the property of THT. As a volunteer of this organization I will not withhold, sell, or give away any animal entrusted to me by the organization.
Initials*
7. THT assists in the aid and veterinary care of all dogs reporting to the rescue. However, certain diseases are still possible and may be transmittable to animals owned by myself. The vaccination of any animals I possess is solely my responsibility and THT will not be held accountable for any veterinary bills acquired.
Initials*
8. My signature, whether original or any other electronic means, is valid as if it were an original signature.
Initials*
I understand that this is an agreement between myself and THT. By signing this document, I am verifying that I have carefully read this waiver of liability and indemnification agreement and fully understand and agree to the conditions listed above.
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Signature*

Clear
Emergency Contact

First NameLast Name
Emergency Contact Relationship
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Phone Number
Please enter a valid phone number.
Should be Empty:

The Heroic Tail Dog Rescue

References

Emergency Contact

Agreement