Name: Date:
Address:
City: State: Zip:
Phone: Cell: Email:
Birth Date: Allergies:
Work Information:
Employer: Work Number:
Number of hours per week:
Emergency Contact Information:
Name: Phone:
Relation:
Name: Phone:
Relation:
General Information:
Why are you interested in volunteering with Four Paws Sake, Inc.?
Do you currently volunteer with any other organization? Yes No
Please tell us your areas of volunteer interest. (i.e., fostering, transporting, training, etc)
Are you comfortable approaching animals that you do not know? Yes No
Do you understand that all animals are unpredictable and that Four Paws Sake, Inc. cannot, and does not, guarantee the temperament of any animal? Yes No
Are you willing to assume the risks involved with working with animals that are sometimes frightened and may potentially become aggressive and/or bite you or a companion? Yes No
Volunteer Agreement (please initial)
I am at least 18 years of age and can provide current valid picture identification.
I understand that Four Paws Sake, Inc. (“FPS”) will not be held liable for any illness, injury, or accident including disability and death, and/or property damage that may occur while I am volunteering for FPS. I am aware of the risk of illness including but not limited to ringworm, tapeworms, roundworms, hookworms, and mange; the risk of injury including but not limited to scratches and bites; the risk of accidents including but not limited to falling and tripping. I understand that it is my responsibility to seek medical attention should any of the events occur. I understand the importance of washing my hands thoroughly after handling animals to reduce the risk of infection.
I give permission to FPS to treat me in case of an emergency. I understand that FPS will contact both of the emergency contact numbers listed above first for guidance in an emergency situation unless the situation is considered a medical emergency or life threatening, in which case 911 will be called on my behalf. If no guidance is available I give permission to FPS to take the appropriate action in having me seen by a licensed medical professional. I understand that FPS needs a copy of my medical insurance card and I have submitted the copy to them prior to volunteering.
In consideration for being allowed to work as a volunteer for FPS, on behalf of myself, my executors, administrators, heirs, next of kin, successors and assigns, I hereby waive, release, discharge and agree to hold harmless FPS, its employees and its Board of Directors, from any and all claims and liability for any death, disability, injury or damage I may incur whether to my person or my property as a result of my volunteer activities.
I understand that FPS has the right to terminate my volunteer status at any time for any reason without my approval. I also understand that I have the right to rescind my volunteer status at any time, for any reason without FPS approval.
I understand that FPS reserves the right to reject any volunteer application.
Signature: Date:
FPS Witness: Date: