Volunteer Application

Name

First NameLast Name

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.

I certify that as of today's date, I am over 18 years of age:

YesNo

If between 16-18 years old: I certify that the adult person outlined below ('Guardian') will be with me at all times while I am volunteering for Old Drum & Friends Animal Shelter:

YesNo

Guardian's Name

Volunteer Liability Release Form

Release of Liability: I fully understand that as a part of my volunteer work at Old Drum Animal Shelter I will become 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 I 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 on this form acknowledges this volunteer liability release attests to my intent to hold harmless and release from all liability Old Drum Animal Shelter and their agents and assigns from all acts which are related to my performance of any and all volunteer duties.

Tetanus 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.

Photography Release: I agree to allow pictures of myself to be used, without compensation, for the purpose of the promotion and publicity related to Old Drum Animal Shelter.

E-Signature

Date