Reading to Rescues Application

Reading to Rescues Application

Thank you for applying to be a Rescue Reader at the Sioux Falls Area Humane Society, please take the next 10 minutes to thoughtfully and carefully fill out the application. This application is dedicated to ONLY reading enrichment. Ages 6-under 12 welcome with one guardian.
Today's Date *

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Rescue Reader Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Parent/Guardian Birth Date *

MonthDayYear
Date
Rescue Reader Birth Date (Ages 6-under 12)*

MonthDayYear
Date
Driver's License Number*
Emergency Contact Name & Relation *
Emergency Contact Phone Number *
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any allergies or accommodations we should know of?*
Please note that we do not recommend volunteering to anyone with severe allergies to cat hair, dog hair, or dust as these allergens are prominent at the shelter. Peanut Butter and cleaners containing Bleach are used at the shelter as well.
YesNo
If yes, please explain. *
All adult applicants may be subject to a background check as part of the application process. By submitting an application, you consent to the organization conducting any necessary background screenings to determine eligibility. By writing your name below, you have read and agreed to this statement. *

First NameLast Name
- I understand that to stay active on the program, I will participate in RTR 3x a month.*
  Initials
- I understand that I will not be permitted to be hands on with the animals or permitted to open their kennel doors. I understand that I will remain in the kennel area where staff direct me to be.*
  Initials
- Confidentiality: Volunteers and Junior Volunteers are to keep all Humane Society matters confidential, and refrain from speaking to any type of media unless approval is received from the executive director.*
  Initials
- I understand that I am not allowed to bring other people who are not registered volunteers including other children, friends, relatives, etc without prior approval. I understand that to prevent stress to the animals, one child with one adult will be allowed to read per family at one time.*
- In the event that I become a member of the Sioux Falls Area Humane Society Volunteer Program, I agree to abide by all present and subsequently issued rules of the Sioux Falls Area Humane Society: *
  
  Clear
- It is agreed that all risks attendant to watching and/or participating in shelter activities, including, but not limited to bodily injury, are assumed by the participant and that this assumption is acknowledged, approved, and agreed to by said participant as indicated by the signature hereto. The Sioux Falls Area Humane Society will not take liability for any injuries sustained during activities. I hereby grant permission for consideration for honoring the participant’s request to participate in the above activity, I, for myself, my executors, administrators, and assigns, do hereby release and forever discharge the Sioux Falls Area Humane Society, its Board of Trustees, its respective entities, administrators, members, volunteers, employees, or agents from any claims that I might have myself or could bring on the participants behalf with regard to damages, demands, or any actions whatsoever, including those based on negligence or failure to supervise, in any manner arising out of the participant’s participation in this activity. I grant full permission to any and all of the foregoing to use my name, photographs, video, or other recordings of our participation in volunteer activities for any lawful purpose without obligation or liability to me.*
  Initial
- I hereby agree to save, hold harmless, and indemnify the Sioux Falls Area Humane Society, its Board of Trustees, and/or its respective entities, administrators, members, employees, volunteers, or agents against any and all claims, including claims of negligence or failure to supervise, which the participant might bring against them as a result of his or her participation in the above activity.*
  Initials
- I recognize that this Release means that I am giving up, among other things, rights to sue the Sioux Falls Area Humane Society its Board of Trustees, its respective entities, administrators, volunteers, members, employees, agents for injuries, damages or losses that I may incur.*
  Initials
- Signature*
  
  Clear
- Today's Date*
  
  MonthDayYear
  Date
- **The Sioux Falls Area Humane Society reserves the right to decline any volunteer application for any reason. This may include, but is not limited to any area where there is a conflict of interest or incomplete application. Due to liability issues, The Sioux Falls Area Humane Society does not have a program for court ordered or diversion program community service.**
  
  Completing this application does not make you a SFAHS volunteer. You will go through the following process:
  
  1. Application submitted. Please allow 3-5 business days to process.
  2. If application is approved, you will be contacted to schedule your orientation and reading enrichment sessions.
- Please verify that you are human*
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