Volunteer Application Form

Volunteer Application:
Being a caretaker to an animal is a big responsibility. Therefore, Animal Care Sanctuary (ACS) wants to make sure that all of our volunteers recognize the importance of providing emotional and physical care for our residents. We ask that you read and complete this application thoroughly. It should be made clear that ACS reserves the right to deny the application of any volunteer, for any reason except those prohibited by law. Any volunteer age 16-17 must have a parent or guardian sign permitting them to volunteer. Any volunteer under age 16 must be accompanied by an adult while at the shelter. Adult must also have an active volunteer application on file.
Date*

MonthDayYear
Choose a Location*

East Smithfield

Volunteer Information
Full Name*

First NameLast Name
Is this a court ordered Community Service fulfillment?*

YESNO
If you answered "yes" to the above question, please provide the name and contact information of your probation officer in the fields provided below.
Officer's name:

First NameLast Name
Officer's email address:
example@example.com
Phone Number where we can reach your probation officer:

Area CodePhone Number
Please include names and ages of any children under 18 who may be volunteering with an adult:
Do you have a valid drivers license?*

YESNO
Drivers License #*
State Issued:*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:*

Area CodePhone Number
Evening Or Cell #*

Area CodePhone Number
E-mail*
Do you have any special needs or considerations?

Emergency Contact Info
Emergency Contact Person?*

First NameLast Name
Relationship:*
Emergency Home Phone*
Emergency Work Phone
Emergency Cell Phone
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you have health insurance?*

YesNo
Date of last tetanus shot*

MonthDayYear
Do you have any medical conditions that ACS should be aware of in an emergency?*

YesNo
If yes please explain:
Do you have any allergies (medical, animal or environmental) that ACS should be aware of?*

YesNo
If yes please explain:

Animal Handling Experience
Please list all animals you are familiar with, wild and domestic:*
Have you ever humanely trapped an animal?*

YesNo
Have you ever worked with an animal during a disaster?*

YesNo
Have you ever volunteered at an animal shelter?*

YesNo
If yes where?

Release of Liability
Name of Volunteer:*
Date following Releases Signed*

MonthDayYear
RELEASE OF LIABILITY

I, the undersigned, release ACS and its employees and other persons connected with this shelter from any and all liability for damage and injury to myself and I accept full responsibility for any and all such damage and injury. I understand the risks of working with animals and accept those risks. I have been informed that volunteers are not covered by the shelter insurance and acknowledge that I will be working as a volunteer at the shelter at my own risk.
VOLUNTEER*
PARENT/GUARDIAN
CHECK IF YOU ACCEPT THE ABOVE RELEASE OF LIABILITY*

I ACCEPT
TETANUS AND RABIES WAIVER

ACS feels it is important to have a tetanus vaccination before joining the volunteer team. To emphasize the importance, we ask that you read and sign the following waiver:

I understand that because I may handle animals, it is important to discuss being vaccinated against tetanus with my physician. I release ACS from all responsibility for events that may occur if I do not pursue this matter further. I realize that whatever decision I make is at my own risk.

I have been also been advised of the risk of rabies and understand that it is my choice to have the three pre-rabies vaccinations at my own cost.

I release ACS from all legal responsibility and responsibility for any medical care that may be necessary due to injury at the shelter or while I am on shelter business.
VOLUNTEER*
PARENT/GUARDIAN
CHECK IF YOU ACCEPT THE ABOVE TETANUS AND RABIES WAIVER*

I ACCEPT
AS A VOLUNTEER WITH ACS I AGREE TO THE FOLLOWING:
1. To represent ACS in a professional manner while volunteering
2. To respect ACS right to terminate me as a volunteer, should it be determined that I am in conflict with the goals of ACS. ACS has the right to also terminate volunteers if it’s determined a volunteer may be a threat to any animal’s health and well-being
3. To use equipment and facilities belonging, or being used by ACS, in a manner not to damage or destroy them. Volunteers are responsible for replacing and/or repairing any property they intentionally damage or destroy
4. To not represent ACS to the media without the prior approval of ACS
5. To not abuse or neglect any animals, in the care of ACS or otherwise
6. To not cause bodily harm to any other volunteers, staff members
7. To not bring weapons of any kind to the ACS property for any reason
8. Alcohol and illegal drugs are not permitted to be used at anytime when you are volunteering at ACS. If a volunteer violates either, or enters the facility while under the influence of previously ingested substances, they will be dismissed as a volunteer.
9. Smoking and vaping are not permitted.
10. For your protection and the safety of our animals, no sandals, short skirts or shorts, high heels, tank or tube tops are to be worn during volunteer hours. Also no loose items (such as loose necklaces, earrings, ties, etc) should be worn that can entangle you or an animal, possibly causing harm to either.
11. Animals and visitors are to be treated with respect. Language should be professional and a positive attitude displayed when working with animals or dealing with the public
VOLUNTEER*
PARENT/GUARDIAN
I HAVE READ THE ABOVE MENTIONED CONDITIONS AND AGREE TO ABIDE BY THEM WHILE A VOLUNTEER AT ACS:*

I ACCEPT
Signature

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Volunteer Application: