The Jewel Farm Sanctuary Interest Form & Liability Waiver

Please indicate which role(s) you are interested in: volunteering, leadership team, student internship, other.

Name

First NameLast Name

D.O.B./Age:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Current Employer/ Job Title:

May we contact for a reference?

YesNoN/A

If yes, please provide name and phone # of employer reference:

How did you hear about The Jewel Farm Sanctuary?

Why do you want to join The Jewel Farm Sanctuary team?

Do you work with any other rescue organizations?

YESNO

If yes, please provide contact information for that organization including name and phone #:

Allergies or physical restrictions:

Please list any pets you currently own (or have owned in the past).

Animal Experience: (check all that apply)

If you would like to expand on your experience with the above, please do so here:

Other Experience, Special Skills, Strengths, Talents: (check all that apply)

If you would like to expand on your experience with the above, please do so here:

Volunteer Work Preferences: (check all that apply)

How many days a week can you be available?

1 Day2 Days2-4 Days

What shifts would you be able to commit to each week as an animal care crew member?

	8:00am-10:00am	10:00am-12:00pm	12:00pm-2:00pm	2:00pm-4:00pm	4:0pm-6:00pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Are you willing to be on call for emergencies?

YesNo

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

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

Any additional comments:

In case of emergency, who should we contact? (name and phone #)

Liability Waiver: This agreement is entered into as of the date set forth below by The Jewel Farm Sanctuary. WHEREAS, the team member has voluntarily contacted The Jewel Farm Sanctuary and has expressed an interest in working with the sanctuary and animals in the care and custody of The Jewel Farm Sanctuary. In consideration of The Jewel Farm Sanctuary’s agreement to allow the participant to view and interact with such animals, the individual hereby, for their heirs, their personal representatives, and themselves, represent and warrant as follows: 1. The participant is fully aware of the risks that animals pose and have elected to view and interact with one or more animal residents in the care of The Jewel Farm Sanctuary voluntarily. The participant knowingly assumes all risks that exposure to animals may pose, including but not limited to serious bodily injury or death. 2. THE PARTICIPANT HEREBY WAIVES, RELEASES DISCHARGES, HOLD HARMLESS, AND PROMISES TO INDEMNIFY AND NOT TO BRING SUIT AGAINST The Jewel Farm Sanctuary, 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 any 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 animals.

By writing your name here, you are agreeing to the above liability waiver. Please also include the date.

By writing your name here, you are stating that you are the parent/guardian of the above applicant and you grant your permission for them to volunteer with The Jewel Farm Sanctuary.

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

Thank you for your interest in joining The Jewel Farm Sanctuary team!