Volunteer ONLINE Application

Applicant's Name*

First NameLast Name

I am applying to volunteer as a:

CleanerCat Socializer

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

HOME Phone Number

Area CodePhone Number

CELL Phone Number

Area CodePhone Number

WORK Phone Number

Area CodePhone Number

I am over 18 years of age.

YESNO

I am under 18 years of age, but am at least 16 years of age.

YESNO

If I am under 18 years of age, I certify that my guardian* will be with me AT ALL TIMES while I am volunteering at the shelter. Please initial below that you agree:

*Guardian's Full Name

First NameLast Name

Guardian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Guardian's Home Phone Number

Area CodePhone Number

Guardian's Cell Phone Number

Area CodePhone Number

Guardian's Email Address

Have you ever been investigated by Animal Control for any reason? If so please explain:

I have current health insurance coverage:

YESNO

If you do NOT have current health insurance coverage, you understand that expenses from possible injury will be paid by you personally and not by PAWS Animal Welfare Society, Inc. of Fort Kent:

YES

Please initial that you confirm:

You are strongly urged to have a current tetanus vaccination to protect yourself should you be cut, scratched or otherwise injured in such a way that tetanus infection could threaten your health. I have read this and have been advised.

YES

Please initial that you confirm:

I understand that the behavior of domestic animals is at times unpredictable and that some domestic animals are capable of inflicting property damage, serious personal injury, and even death. I am well aware of the risks of handling domestic animals, and with such understanding, I hereby waive, release and forever discharge PAWS Animal Welfare Society Inc. of Fort Kent from any and all claims (whether present or future) arising out of the my participation in the Volunteer Program.

YES

Please initial that you confirm:

Release of Liability: I fully understand that as a part of my volunteer work with PAWS Animal Welfare Society Inc. of Fort Kent,I will become in contact with animals either by direct handling or assisting in their care. Further, I understand that working with animals carries a risk of injury, and that it is possible that I may be bitten, scratched, and/or otherwise injured. I also understand that I may be exposed to feline illness and disease and that it is also possible that I could indirectly expose my own pets to such illness and disease. My signature to this volunteer liability release attests to my intent to hold harmless and release from all liability the PAWS Animal Welfare Society Inc. of Fort Kent,and their agents and assigns from all acts, which are related to my performance of any and all volunteer duties.

YES

Please initial that you confirm:

Guardian's signature to confirm (if applicable):

By signing electronically you agree your electronic signature is the legal equivalent of your manual signature on this form.

Medical Release: In case of emergency, I authorize PAWS Animal Welfare Society Inc. of Fort Kent to arrange emergency medical treatment after attempting to notify the contacts listed below.

YES

Contact #1 Full Name

Contact #1 Phone Number

Relationship to you:

Contact #2 Full Name

Contact #2 Phone Number

Relationship to you:

Applicant's Signature:

By signing electronically you agree your electronic signature is the legal equivalent of your manual signature on this form.

Thank you for your interest in volunteering. We look forward to working with you.

~PAWS Animal Welfare Society, Inc. of Fort Kent Board

Volunteer was trained by:

On this date:

Volunteer Application & Liability Release Form