Volunteer Application and Waiver of Liability

APPLICANT

First Name: *

Last Name: *

Street Address: *

City: *

State: *

Zip Code: *

Home Phone:

Cell Phone: *

Work Phone:

E-Mail Address: *

Full Name

Do you have a Driver's License? * Yes No

Note: At times volunteers help by transporting animals. Per our insurance, we need the driver's license information of a person helping with transportation.

State: *

Driver's License Number:

Birth Day *

Birth Month *

Birth Year *

Date of Birth

Today's Date

Age *

I understand volunteers under 17 years of age will require an adult (18 or over) to be present when volunteering. * Agree Disagree

I understand volunteers under 18 years of age will require an Electronic Signature from Parent or Guardian at the bottom of this form. * Agree Disagree

ADDITIONAL INFORMATION

Other:

Are you on Facebook? * Yes No

Have you volunteered for any other animal organizations? * Yes No

If yes, who?

What type of Volunteer Work are you interested in? (You can choose any (no limit) from our volunteer opportunity list or tell us what talent you possess that you would like to incorporate with our group (list below)): Cats & Kittens Adult Dogs Puppies Foster Photography Transportation Fundraising Other (please list below)

Additional Talents:

Explain any experience with caring or working with animals you feel may benefit our organization.

How much time (hours, days etc.) per month would you like to devote to volunteer work with Adopt Me! Bluegrass Pet Rescue? Please note: We ask for a minimum commitment of 1.5-2 hrs/week.

What is your preferred timing for volunteering (check all that apply): Any Notes or Comments (please list below) Morning Midday Late Afternoon Weekdays Weekends

Additional Comments/Notes regarding your preferred timing:

Do you have any conditions or limitations that would prevent you from specific volunteer activities that we should be aware of? * Yes No

If yes, please list any condition(s) you wish to disclose.

EMERGENCY CONTACT INFORMATION (Primary)

Please enter the Information below for an Emergency Contact. If desired, a second Emergency Contact maybe listed.

First Name: *

Last Name: *

Same Address as Applicant:

Street Address: *

City: *

State: *

Zip Code: *

Phone: *

E-Mail Address: *

EMERGENCY CONTACT INFORMATION (Secondary)

First Name:

Last Name:

Same Address as Applicant:

Street Address:

City:

State:

Zip Code:

Phone:

E-Mail Address:

WAIVER OF LIABILITY

I understand as a volunteer with Adopt Me! Bluegrass Pet Rescue, I may come in contact with animals with unknown histories. * Agree Disagree

I understand these animals may have undiagnosed diseases, conditions, and/or behavioral problems that are unknown to Adopt Me! Bluegrass Pet Rescue. * Agree Disagree

I am willing to undertake the risks of working with animals of unknown history and/or temperament. * Agree Disagree

I do not hold Adopt Me! Bluegrass Pet Rescue, its Board or volunteers responsible for any injuries or illnesses that I may encounter while volunteering. * Agree Disagree

I understand the risks involved and willingly participate in volunteer activities on behalf of Adopt Me! Bluegrass Pet Rescue. * Agree Disagree

I hereby grant Adopt Me! Bluegrass Pet Rescue permission to use photographic images of me, or photos that may include my image, for use in publications, including social media and website. * Agree Disagree

CODE OF ETHICS & CONDUCT

COMPLIANCE WITH LAW: Volunteers must work to protect the organization by complying with all laws, state and federal. Legal action may be taken in cases of theft, embezzlement, corruption, or other unlawful actions. * Agree Disagree

SAFETY: All volunteers should respect each other and our potential adopters. Any discriminatory behavior or harassment will not be tolerated. Additionally, any volunteers dealing with our rescue dogs and cats should treat each with respect and use common sense in remembering these are animals and can act out when scared or startled. You must report any safety violations or incidents to a Board Member immediately. * Agree Disagree

INTEGRITY: Each volunteer must show integrity and professionalism in every aspect of conduct, including social media, always remembering they are representing AMBPR. * Agree Disagree

CONFLICT OF INTEREST: Each volunteer must protect AMBPR’s tax-exempt interest. The organization is charitable, and, in order to maintain our federal tax exemption, all volunteers must engage primarily in activities which accomplish one or more of its tax-exempt purposes. * Agree Disagree

PROPRIETARY INFORMATION AND ASSETS: All Adopter lists, applications, communications, social media, assets (including, but not limited to, animals, monies, equipment, food, buildings, and medicines), documents, and/or anything else the Board deems proprietary, shall be deemed the sole property of AMBPR. Any misuse or abuse, including sharing or using for one’s own gain, of said information or assets may result in termination and/or legal action. * Agree Disagree

SIGNATURE

Applicant Signature: * (Please type your Full Name in the Box below) *

* Agreement: By entering my name in the box above, I confirm that to the best of my knowledge, all information furnished in this application is true and correct.