HUMANE SOCIETY OF MORGAN COUNTY VOLUNTEER APPLICATION

Do you have a truck?  Y/N
Date: _____/_____/_____

Name: _______________________________________________________________________________ Address: _____________________________________________________________________________
City, State, Zip: _______________________________________________________________________
Home phone: ______________________________ Work phone: _______________________________
Cell phone: ________________________________ Are you 16 or older?  Y / N
Email address: ________________________________________________________________________
Employer name: ________________________ May we contact you at work? _____________________
Why are you interested in becoming a volunteer at the shelter? _________________________________ _____________________________________________________________________________________
List any special skills you have that would be valuable to the shelter: ____________________________
_____________________________________________________________________________________
What experience do you have with animals? ________________________________________________ _____________________________________________________________________________________
What pets do you currently own or have owned in the past? ___________________________________ _____________________________________________________________________________________
Have you ever had an animal complaint filed against you?  Y / N
If so, please explain: ___________________________________________________________________
_____________________________________________________________________________________
Which areas of the shelter would you like to volunteer for? _____________________________________
_____________________________________________________________________________________
What things do you NOT want to do? ______________________________________________________
When are you available? (Please be sure to indicate morning or afternoon, and the day of the week)

Do you have any physical limitation or health restrictions of which HSMC should be aware?  Y / N
If so, please explain: ___________________________________________________________________
Emergency contact: ________________________________ Phone number: ______________________
Physician name: ___________________________________ Phone number: ______________________

I, as a volunteer service provider to the HSMC, hereby acknowledge knowingly, freely and voluntarily waiving my right or cause of action of any kind whatsoever arising as a result of such activity from which any liability may or could occur against HSMC or its agents or employees jointly or individually. I declare that I shall not hold the HSMC liable for any illness, injury or disease that I might contract or sustain while I am working in said capacity. I also understand that I am not covered under workers’ compensation. I fully recognize the dangers associated with the work of the HSMC and I freely consent to this waiver. The HSMC makes no representations concerning any animals’ exposure to rabies or other diseases.

Signed: ____________________________________________________ Date: ____________________

Print: ______________________________________________________