CITY OF PAWTUCKET
POLICE DEPARTMENT
Tina Goncalves
CHIEF OF POLICE
Donald Grebien
MAYOR
Pawtucket Animal Shelter Volunteer Application
Name:
Date of Birth:
-
Month
-
Day
Year
Date
Address:
City/State:
Email:
example@example.com
Phone:
Experience with animals:
Areas interested in volunteering:
Dog walking/enrichment
Cat enrichment
Birds/rabbits/etc. enrichment
Adoption assistance
Animal welfare
Facility maintenance
Availability (days of week/times of day):
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CITY OF PAWTUCKET
POLICE DEPARTMENT
Tina Goncalves
CHIEF OF POLICE
Donald Grebien
MAYOR
STATE OF RHODE ISLAND CRIMINAL RECORDS CHECK CONSENT AND DISCLAIMER FORM
FULL LEGAL NAME:
MAIDEN/ALIAS NAMES:
DATE OF BIRTH:
-
Month
-
Day
Year
Date
SEX:
I,
SIGNATURE:
DATE:
-
Month
-
Day
Year
Date
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CITY OF PAWTUCKET
POLICE DEPARTMENT
Tina Goncalves
CHIEF OF POLICE
Donald Grebien
MAYOR
WAIVER AND GENERAL RELEASE OF LIABILITY
The undersigned,
permitting me to participate in Volunteer Activities at and/or on behalf of the Pawtucket Animal Shelter from
to
hereby:
1. Acknowledges and fully understands that his/her participation in the Program may involve the risk of physical injury, and risks unknown or unforeseeable at this time, including, but not limited to, animal bites.
2. Assumes any and all of the foregoing risks for any and all of the losses, harm, damages, medical expenses, and/or any other consequences of any kind or nature, resulting from my involvement in the Program.
3. Understands that animals are unpredictable and may bite. I also understand that the dogs at the shelter are of an unknown temperament and that there is a risk of bite or injury from any animal at the shelter.
4. Releases, holds harmless, waives, forever discharges and indemnifies the City of Pawtucket, and his/their respective agents, representatives, employers, employees, attorneys and any other owner or party with an interest in the Program from any and all manner of action, causes of action, claims, suits, and liabilities, both at law and in equity, whether known or unknown, foreseen or unforeseen, arising out of my involvement in the Program.
5. I understand that my participation in this program I may come upon confidential police or health care information. By executing this document, I hereby agree not to disclose said information to non-essential persons.
6. This Waiver and General Release of Liability ("Waiver") may not be modified in any way. If any part of this Waiver is determined to be invalid, all other parts of this Waiver shall remain valid and enforceable. This Waiver shall be interpreted and construed in accordance with the laws of the State of Rhode Island.
7. By executing this Waiver, the undersigned acknowledges that he/she has entered into this Waiver knowingly, intelligently, voluntarily, and as an act of his/her own free will.
8. The undersigned party agrees that to the extent the undersigned shall take any other person with them into the Program, the undersigned shall cause such person(s) to execute this Waiver and shall indemnify the City of Pawtucket to the extent that said execution is not obtained.
IN WITNESS WHEREOF, I have signed and executed the foregoing waiver and general release of liability this
day of
-
Month
-
Day
Year
Date Picker Icon
2024
Signature
Print name
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CITY OF PAWTUCKET
POLICE DEPARTMENT
Tina Goncalves
CHIEF OF POLICE
Donald Grebien
MAYOR
VOLUNTEER DOG WALKERS RULES AND RESPONSIBILITIES
Applicable to Volunteers who when acting as dog walkers
1) Dog walkers must be in compliance with all city ordinances (i.e. leash law, pooper scooper, ballfields prohibited, etc.).
2) Shelter dogs are not allowed in or near the dog park.
3) Dog walkers must not allow shelter dogs to interact with other dogs/animals/or people while on the walk.
4) Dogs must stay in the park at all times.
5) Dogs must not go into any vehicle during their walk.
6) Dogs must not be allowed to drink stagnant water or water out of communal bowls.
7) Dogs must not be allowed to go into the pond or any other body of water.
8) Dogs must not be fed or given any medication by the volunteers (treats provided by the shelter are permitted).
9) Dogs must remain on leashes, collars or harnesses provided by the shelter.
10) Dogs must remain in the custody of the approved volunteer and cannot be given to someone else during their walk time.
Signature:
Print Name:
VOLUNTEER RULES AND RESPONSIBILITIES
Applicable to all Volunteers
1) Volunteers shall follow all verbal and written instructions by the staff of the Pawtucket Animal Shelter that relate to the performance of any volunteer activities.
2) Certain activities may carry some risk of injury. For example, mopping a floor or carrying water for dogs may result in wet and slippery conditions on a floor.
3) Volunteers will advise staff of any condition of which they become aware that may increase the risk of physical injury and shall take all reasonable precautions to avoid that risk of injury.
4) Where and when appropriate, volunteers shall utilize resources, such as warning signs, to warn others of any potential risk.
Signature:
Print Name:
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