City of Independence
Animal Shelter Volunteer Application
Volunteer Room 325-7212 PO Box 1019
Main line 325-7205 875 Vista Dr
Fax 325-7215 Independence, MO 64056
The Independence Animal Shelter encourages volunteer participation in efforts to improve the lives of animals and people in Independence. Our goals are:
1. Protect the people of Independence from animal illnesses, injuries and nuisances.
2. Provide basic animal comfort and care at the shelter.
3. Return as many animals as possible to their owners or place them in responsible homes.
4. Humanely dispose of those animals that cannot be placed.
5. Inform the public about the location and services of the Independence shelter.
6. Comply with applicable governmental rules and regulations.
All volunteers are required to attend an orientation before they begin helping at the shelter. At this orientation, volunteer opportunities will be explained to you. Volunteers must also be current on their tetanus vaccination and be at least 14 years old.
PLEASE PRINT Date______
Name:______Birth Date ______
Address:______
(mailing address including city, state and zip)
Day phone ______Evening phone______
In case of an emergency, who should we contact?
Do you have any special health problems or needs we should know about?
Why do you want to volunteer at Independence Animal Shelter?
Please list any previous volunteer experience:
Please list any previous experience working with or handling animals:
What kinds of skills, hobbies, training or talents would you like to utilize in your volunteer work?
Are there any specific areas in which you wish to gain experience or receive special training?
Do you have any specific animal welfare interests?
How did you learn about volunteer opportunities with our shelter?
What are your thoughts on euthanasia?
What are your thoughts on spaying/neutering?
What pets do you have in your home?
AREAS OF INTEREST
______counseling clients adopting animals ______fund-raising______Grant writing
______bathing & brushing animals ______artist ______photographer
______public education
I agree to abide by the policies, procedures and guidelines of the Independence Animal Shelter as explained to me by the shelter staff, and I agree to become familiar with the written volunteer guidelines for the shelter.
I understand that I may be asked to do any type of volunteer work that is needed. I understand that this is an unpaid volunteer position and that I can expect no reimbursement for myself or the use of my vehicle or equipment.
I hereby represent that my motor vehicle and I are insured pursuant to the laws of my state of residence and I will maintain this insurance during any time I work as a volunteer for the Independence Animal Shelter and am called upon to use my car.
I will not hold the City of Independence liable or responsible for, and the City shall be saved and held harmless from and against, any and all claims and damages of every kind, for injury to any person or persons and for damage to or loss of property, arising out of or attributed directly or indirectly to my operations or performance as a volunteer under this agreement.
Signature:______Date:______
Name: (Please Print)______
Guardians Signature:______Date:______
( if under age 18 or have a legal guardian)