Volunteer Animal Rescue Application Form

Camp Chaos Big Paw Rescue Inc.

Volunteer Request Form

First and Last Name*

D.O.B./Age*

Street Address*

City*

State*

Zip*

Home Phone

Work Phone

Cell phone*

Email Address*

example@example.com

Employer/Job Title*

If yes, please provide name and phone # of employer

Allergies or Physical Restrictions*

How did you hear about Camp Chaos Big Paw Rescue?*

Why do you want to volunteer at Camp Chaos Big Paw Rescue?*

Do you work with any other rescue groups? If so, please give contact information for the organization including name and phone#:*

Please list all pets currently living in home along with Breed, Age and Sex (Neutered/Spayed?)*

Animal Experience: (check all that apply)*

Volunteer Work Preferences: (check all that apply)*

When would you be available typically to perform these tasks? Please list days of the week and times each day*

Reference #1 (Name, phone # and relationship to self)*

Reference #2 (Name, phone# and relationship to self)*

Vet Reference (Name)*

Vet Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Vet Phone Number

In case of emergency, who should we contact? (Name and Phone#)*

This volunteer agreement ("Agreement") is entered into as of the date set forth below by Camp Chaos Big Paw Rescue. WHEREAS, the Volunteer has voluntarily contacted Camp Chaos Big Paw Rescue and has expressed an interest in working with dogs in the care and custody of Camp Chaos Big Paw Rescue. In consideration of Camp Chaos Big Paw Rescue's agreement to allow the volunteer to view and/or interact with such dogs, the volunteer hereby, for his/her heirs, his/her personal representatives, and him/herself represent and warrant as follows: 1. The volunteer is fully aware of the risks that dogs pose and has elected to view and/or interact with one or more dogs in the care of Camp Chaos Big Paw Rescue voluntarily. The volunteer knowingly assumes all risks that exposure to dogs may pose, including but not limited to serious bodily injury and/or death. 2. THE VOLUNTEER HEREBY

WAIVES, RELEASES DISCHARGES, HOLD HARMLESS, AND PROMISES TO INDEMNIFY AND NOT TO BRING SUIT AGAINST Camp Chaos Big Paw Rescue, its directors, officers, volunteers, staff, and all other agents, and attorney for any of the referenced parties and any other parties acting for or on behalf of the referenced partied from and all rights and claims which the volunteer has or which may hereafter accrue to the volunteer and from any and all damages which may be sustained by the volunteer directly or indirectly in connection with, or arising out of, the volunteer's exposure to such dogs.

By typing your name here, you are agreeing to the above liability waiver.*

Please Type Your Name Here Acknowledging the Above Statement*

Date:*

Anything else you would like to say, please note it here:

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