INTERNSHIP APPLICATION

TEEN INTERNSHIP APPLICATION

Hayward Police Department- Animal Services Bureau
Date:

MonthDayYear
Date
Name of School:
Grade:
Age:
Name of Student:

First NameLast Name
Phone:
Format: (000) 000-0000.
Birthdate:

MonthDayYear
Date
E-mail of Student:
example@example.com
CDL or CID:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City:
Zip:
Number of Volunteer Hours Needed:
Start Date:

MonthDayYear
Date
End Date:

MonthDayYear
Date
Days would come in for internship (Ex. Every Wednesday) :
Hours would be here fore internship (Ex. 8:30am - 12pm) :
Name of Student Advisor:

First NameLast Name
Advisor Contact Phone:
Format: (000) 000-0000.
Advisor's Contact E-mail:
example@example.com
Parent/Guardian Name:

First NameLast Name
Parent Phone:
Format: (000) 000-0000.
Parent CDL:
Parent Birthdate:

MonthDayYear
Date
Any medical condition(s) that may limit you or your ability to:Lift or handle animals?
To walk a lot?
If yes, please
explain:
Do you have any allergies?
Medical Treatment Authorization
In case of medical emergency where I am not able to authorize medical treatment for myself or my child, I hereby expressly give my permission to the activity supervisor to contact 9-1-1 for whatever reasonable medical care is necessary and for which I hold the City harmless.
Company providing medical insurance?
Emergency Contact Name & address:
Name of Physician:
Secondary Emergency Contacts:
Name/Relationship:

First NameLast Name
Phone:
Format: (000) 000-0000.
Home Phone:
Format: (000) 000-0000.

City of Hayward - Volunteer - Background Questionnaire
Have you reviewed the internship program brief? If so, do you have any questions or concerns?
YesNo
If yes, please describe the crime for which you were convicted, the date of conviction and the jurisdiction in which you were convicted:
YesNo
If yes, please describe the crime for which you are on bail, the jurisdiction where it occurred, and if convicted, the conviction:
Volunteer Agreement (Parent please complete)
1. In consideration of the City's authorization to allow my child to participate as a volunteer in the activity(ies) listed above, I hereby agree and acknowledge:
a. that the City of Hayward, its officers, employees, agents, volunteers, and sureties, and each of them shall not be responsible or liable for any wrongful death, personal injury, or damage or loss of property incurred by me or my child while participating in the activity(ies), whether the same shall arise by the negligence or omission of any said persons., or otherwise.
b. That it is my express intention, by this instrument, to exempt and relieve the City of Hayward, its officers, employees, agents, volunteers and sureties from liability for personal damage, property damage, or wrongful death caused by my or my child's negligence.
c. That for myself and any and all heirs, executors, administrators and assigns, I hereby release the City of Hayward, its officials, officers, directors, employees, agents, volunteers, and sureties, and each of them, and agree to defend, indemnify, and hold the City of Hayward, its officials, officers, directors, employees, agents, volunteers, and sureties, and each of them, harmless from and against any and all loss, liability, damage, including but not limited to, reasonable attorney's fees, consultant and expert fees and/or court costs, directly or indirectly arising out of or in connection with my or my child's participation in any activity(ies) as a volunteer.
d. That for myself and for my child, I hereby waive application of California Civil Code Section 1542. I certify that I have read the following provisions of California Civil Code Section 1542: "a general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor."
I understand and acknowledge that the significance and consequence of this waiver of California Civil Code Section 1542 is that even if I should eventually suffer additional damages arising out of my or my child's participation as a volunteer for the City, I will be unable to make any claim for those damages. Furthermore, I acknowledge that I intend these consequences even as to claims for damages that may exist as of the date of this release but which I do not know exist, and which, if known, would materially affect my decision to execute this release, regardless of whether the lack of knowledge is the result of ignorance, oversight, error, negligence, or any other cause.
2. I give the City of Hayward and any other media sources my full permission to use my or my child's name and/or pictures, or voice recordings, for any publicity and/or promotional purposes without obligation or liability to me.
3. I agree to a DMV background check as part of the City of Hayward's volunteer application process, and I agree to allow the City to use my driver's license number or California ID number to screen me for purposes of a criminal background check.
4. I have carefully read this entire document and understand its terms and their legal significance. This waiver, release and indemnification are freely and voluntarily given in return for allowing myself and my child participation as a volunteer in the activity(ies) listed above. My signature is intended not only to bind myself but all successors, heirs, representatives, administrators, and assigns that I may have. No oral representations, statements or inducements apart from this written agreement have been made.
5. I certify that all of the information provided in this application is true and correct. I agree that the City of Hayward can terminate my volunteer assignment at any time without cause and without notice.
Parent/Guardian Signature:

Clear
Date:

MonthDayYear
Date
Child's Name:

City of Hayward Animal Services -Intern Commitments
Intern Name:
- I will inform my internship supervisor if I will be absent or late to my internship shift.
- I will inform my internship supervisor if I will be unable to complete my internship.
- I will perform only the duties of my internship assignment as required by my supervisor.
- I will remain in the Hayward Animal Shelter Internship program for the minimum commitment indicated in the program.
- I will not socialize with city staff or participants outside of the Hayward Animal Shelter's Program.
- I will not obtain phone numbers, e-mail addresses, or home addresses from program clients for personal use.
- I will follow City of Hayward rules and I will behave appropriately. I will support City of Hayward policies.
- I will maintain the confidentiality of the City's confidential information and I will not use such information for any personal use.
- I will be free of the influence of alcohol or illegal substances when interning.
- I will follow the appropriate dress/clothing guidelines.
- I will inform the supervisor of any changes in my address, phone numbers, or emergency contacts.
- I will not bring any friends, family members or other unauthorized people to my internship assignment.
- I will attend any training required for my internship position, and I will volunteer at the required times in order to remain an intern.
- I acknowledge that the City can dismiss me at any time as an intern without notice and without cause.
I understand and agree with the above commitments and policies
Youth Volunteer Signature:

Clear
Date:

MonthDayYear
Date
Student Advisor Signature:

Clear
Parent/Guardian Signature:

Clear

Hayward Animal Services
Parental Consent Form
(To be completed for all volunteers age 17 and younger)
I,
the parent or legal guardian of
choose to permit
to participate as a volunteer. I understand that my child's or ward's services are being offered on a voluntary basis without anticipation of any financial remuneration. I agree that he/she will abide by any rules and direction provided by those helping to administer the volunteer internship program. He/She will report any injury or incident to his/her supervisor immediately. I agree familiarize myself and my child, and comply with, Hayward Animal Services policies and procedures applicable to volunteers. In particular, I fully understand that Hayward Animal Services expects high standards of moral and ethical treatment of the animals under its care. I and my child will adhere strictly to these standards as volunteers.
Release
1. I understand that my child will be expected to meet all the requirements of the volunteer position, including regular attendance and adherence to agency policies and procedures. If my child does not meet all volunteer requirements I understand I may be contacted regarding their performance and my child may be dismissed from the program or be unable to receive credit for their volunteer hours.
2. I understand that if my child is 16-17 years of age, they will be volunteering as an individual and may not be directly supervised by a staff member or adult while performing volunteer duties and activities.
3. I understand that the handling of animals and other volunteer activities including but not limited to parades, adopt-a-pet-events, and fostering on behalf of Hayward Animal Services may place me or my child in a hazardous situation and could result in injury to me, my child or our personal property including death. On behalf of myself, and my heirs, personal representatives and assigns, I hereby release, discharge, indemnify and hold harmless Hayward Animal Services and it's directors, officers, volunteers, members and agents from any and all claims, causes of my actions and demands of any nature, whether known or unknown, arising out of or in connection with my or my child's volunteer activities on behalf of Hayward Animal Services.
As a parent or legal guardian of the above mentioned volunteer, I hereby give consent for my child or ward, as the case may be, to become a volunteer for Hayward Animal Services as described in the above volunteer agreement and, by the signature below, join in and agree to be bound by the terms and conditions of the release.
Signature of Parent or Legal Guardian:

Clear
Date:

MonthDayYear
Date
Should be Empty:

TEEN INTERNSHIP APPLICATION

Secondary Emergency Contacts:

City of Hayward - Volunteer - Background Questionnaire

Volunteer Agreement (Parent please complete)

City of Hayward Animal Services -Intern Commitments

Hayward Animal Services

Parental Consent Form

Release