Volunteer Application Form

Name*

First NameLast Name

Birthday MM/DD/YY:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone*

Area CodePhone Number

Cell Phone*

Area CodePhone Number

Email Address:*

Occupation:*

Allergies or physical restrictions:*

How did you hear about CT Animal House?*

Why do you want to volunteer for CT Animal House?*

Do you work with any other rescue organizations currently?*

YesNo

If so, please give contact information for that organization including name and phone #:*

Please list any pets you currently own (or have owned in the past).*

Animal Experience: (check all that apply)*

Please describe your volunteer experience above:*

Other Experience, Special Skills, Strengths, Talents: (check all that apply)*

If other, describe here:

Volunteer Work Preferences: (check all that apply)*

When are you available to volunteer? (check all that apply)*

WeekdaysWeekends

Reference #1*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship:*

Reference #2:*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship:*

Emergency Contact: *

Phone number & relationship to you

This volunteer agreement (“Agreement”) is entered into as of the date set forth below by CT Animal House Inc. WHEREAS, the Volunteer has voluntarily contacted CT Animal House Inc. and has expressed an interest in working with dogs in the care and custody of CT Animal House Inc. In consideration of CT Animal House Inc's agreement to allow the volunteer to view and/or interact with such dogs, the volunteer hereby, for his/her heirs, his/her personal representatives, and him/herself represent and warrant as follows:

1. The volunteer is fully aware of the risks that dogs pose and have elected to view and/or interact with one or more dogs in the care of CT Animal House Inc. voluntarily. The volunteer knowingly assumes all risks that exposure to dogs may pose, including but not limited to serious bodily injury and/or death.

2. THE VOLUNTEER HEREBY WAIVES, RELEASES DISCHARGES, HOLD HARMLESS, AND PROMISES TO INDEMNIFY AND NOT TO BRING SUIT AGAINT CT ANIMAL HOUSE INC., its directors, officers, volunteers, staff, and all other agents, and attorney for any of the referenced parties and any other parties acting for or on behalf of the referenced partied from an and all rights and claims which the volunteer has or which may hereafter accrue to the volunteer and from any and all damages which may be sustained by the volunteer directly or indirectly in connection with, or arising out of, the volunteer’s exposure to such dogs.

By signing here, you are agreeing to the above liability waiver.*

Print First & Last Name

Signature*

By signing here you are stating that you are the parent/guardian of the above applicant and you grant your permission for them to volunteer with CT Animal House Inc.*

Print First & Last Name

Signature:*