Volunteer Application Form

Waller Animal Shelter & Rescue Volunteer Form

Before one can volunteer with the shelter, You must submit this form and attend our training classes. You must sign this Release of Liability.
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Skillsets or Area of Interests
Days of Work

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
I certify that, as of this date, I am over the age of 18yrs old. (initial below)
(Only for Under 18yrs old) I certify that as of this date, I am under the age of 18, but over the age of 16 and that my parents or guardian will accompany me at all times while volunteering at the shelter. Please list Parent or Guardians name and contact information.
I certify that in order to protect outside pets from contracting any potential shelter diseases and to prevent shelter pets from developing illness from outside pets, that all of your personal pets in home are current on all rabies, distemper, parvo and bordetella shots. Initial Below
Type Initials Here
RELEASE OF LIABILITY - I acknowledge and understand that I am a volunteer. I am not an employee of the City of Waller. I do not expect, nor will I receive any salary or compensation for volunteer services I perform for the city. I am not entitled to, nor will I receive any of the benefits or privileges that are received by city employees. I agree to observe and obey all applicable rules and warnings, agents or officials. I fully understand that as a part of my volunteer activities at the City of Waller Animal Shelter and Rescue, I will come in contact with animals either by direct handling or assisting in their care. I understand that working with animals carries a risk of injury. 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 or disease, and I could indirectly expose my own pets to such illness or disease. Therefore, I assume full responsibility for any injuries or illnesses that I may suffer or be exposed to and the cost of any medical treatment that I may require. I further release and discharge the City of Waller for any injuries, illness, loss or damage arising out of my volunteer activities. I agree to indemnify, defend and hold harmless the City of Waller against all claims, damages and causes of action, judgements, cost or expense which may arise from by volunteer activities at the City of Waller Animal Shelter & Rescue. Photo Release - I agree that pictures of me or which include my likeness may be used by the city without compensation, for the purpose of the promotion and public advertisement and dissemination of information related to the City of Waller Animal Shelter. *
Type name here
SPECIAL NOTE: I have been strongly advised to obtain a current tetanus vaccination to protect myself from against possible infection in the event that I receive any cuts, scratches or other injuries. *
Type Initials Here
EMERGANCY CONTACTS: In the event of an emergency, please contact the person listed below at the phone number noted beside the person's name. If the persons listed can not be reached, and there is an immediate need for medical treatment, I hereby authorize the City of Waller to take such action as necessary to transport me to the nearest medical facility or hospital. *
List Two Emergency Contacts with Phone Numbers Here.
Signed and Executed this _____ Day of ________ Signature ___________________________ *
Type (full name) Above. Select today's date below.
Date

MonthDayYear
Date
Should be Empty:

Waller Animal Shelter & Rescue Volunteer Form