VOLUNTEER APPLICATION & WAIVER

Date

Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email Address

example@example.com

Date of Birth (If applicant is under 18)

Date

Parent/Guardian Name (If applicant is under 18)

Parent/Guardian Phone

Please enter a valid phone number.

Do you have any pets?

What type of pet(s)?

What day(s) of the week would you like to volunteer?

What time of day would you like to volunteer?

MorningAfternoonEvening

Which animals would you prefer to work with?

Do you have ANY allergies?

If yes, what kind?

What PET CARE activities would you like to do? (select all that apply)

What GENERAL ACTIVITIES would you like to do?

Why would you like to volunteer?

Any other info you would like us to know about yourself?

Emergency Contact Person

First NameLast Name

Emergency Contact Relationship

Emergency Contact Phone Number

Please enter a valid phone number.

In consideration of being allowed to volunteer or perform community service at the Humane Society of Ottawa County, an Ohio not-for-profit corporation (HSOC), the undersigned (or the parent/guardian if the volunteer is under age eighteen) hereby states and agrees as follows:

I understand that in the course of my volunteer activities I will be working with and around animals at the HSOC facility or at other locations. I understand that there are serious and unpredictable risks of injury or illness associated while working with and around animals. I, knowingly, voluntarily and expressly assume that risk.
I hereby agree to release and forever discharge and hold harmless HSOC, it's officers, directorsemployees, other volunteers, successors and assigns from any and all liability, claims and demandsof whatever kind of nature that may arise in connection with my volunteer activities at/for HSOC.
I hereby agree that if I am injured in the course of my volunteer activities and am unable to give my consent, HSOC may administer treatment that it deems necessary or appropriate and/or may summon appropriate medical assistance. I hereby release and forever discharge HSOC, it's officers, directors, employees and other volunteers from any claim that may arise on account of any first aid, treatment or service rendered to mein connection with my volunteer activities at/for HSOC.
I herebygrant and convey to HSOC all right, title and interest in any and all photographic images or video/audio recordings made by HSOC or an agent thereof in the course of my volunteer activities at/for HSOC>
I understand and agree that this Release and Waiver of Liability discharges HSOC, it's officers, directors, employees, other volunteers, successors and assigns from any liability or claim that I may have with respect to any bodily injury, personal injury, illness, death or property or other damage that may result from my volunteer activities at/for HSOC whether or not causedn by the negligence of HSOC, it's officers, directors, employees, other volunteers. I also understand that HSOC does not assume any responsibility for or obligation to provide any financial assistance or other assistance to me, including but not limited to providing any medical, health or disability insurance.
This Release and Waiver of Liability is governed by the laws of the State of Ohio and is intendedto be as broad and inclusive as permitted by such laws. If any part of this Release and Waiver of Liability is held to be invalid or otherwise unenforceable, the remaining provisions will continue to be valid and enforceable.
I hereby certify that, unless otherwise indicated below, I am at least eighteen years of age and I am freely and voluntarily signing this agreement. I have read this form and understand that by signing it, I am giving up legal rights and remedies.

Signature and Date*

Clear

Date

(The following must be completed if volunteer is under eighteen years of age)

I hereby certify that I am the parent or legal guardian of the minor volunteer named above. I consent to the minor volunteer's activities as a volunteer at/for HSOC and i hereby agree on behalf of the minor volunteer to all of the terms in this Volunteer release and Waiver of Liability.

Parent/Legal Guardian Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Signature of Parent/Legal Guardian

Clear

Date