Volunteer Application and Agreement
Name: _________________________________________
Address: _____________________________________________
Home Phone: ____________ Cell Phone: ____________________
Work Phone: ____________ Can we call you at work? ________
Email:____________________________________
Do you have any physical or psychological limitations or disabilities? (i.e., heart condition, mental illness, learning disabilities, back/knee injuries, epilepsy, etc.) If yes, please explain: ____________________________________________________________________________
Allergies: ____________________________________________________
You are: _____ 16 or younger _____ 17-21 _____ an adult
When are you available for volunteer work?
____ Tuesday _____ Thursday _____ Saturday
____ Wednesday _____ Friday
Volunteer Experience: ____________________________________________________________________________
What is your experience with dog?
___ First-time owner ___ Have had 1 or 2 ___ Experienced
What is your experience with cats?
___ First-time owner ___ Have had 1 or 2 ___ Experienced
What other types of animals have you had experience with? _____________________________________________________________________________
Educational and/or special skills:________________________________________________________________________
Why do you want to volunteer for Blue Mountain Humane Association? _____________________________________________________________________________
Please read the following list of volunteer areas and check those that interest you.
_____Dog Walking _____ Building maintenance
_____Dog Grooming _____ Landscape/Weeding
_____Cat Petting _____ Cleaning
_____Cleaning Cats or Dogs _____ Transport
Other:_______________________________________________________________________
Have you ever been convicted or adjudicated of any kind of animal or human abuse or neglect? ___ Yes ____No
Have you ever been convicted or adjudicated of any violent crime against a person? ____Yes ____No
It is an unfortunate reality that animals must be humanely euthanized at this Shelter. Although you will not be involved with euthanasia, please discuss any questions with us.
I hereby affirm the information given above is true to the best of my knowledge and the Blue Mountain Humane Association permission to use said information in order to obtain data regarding my background.
___________________________________ ____________________
Signature Date
BMHA has the authority to reject any applicant if it is determined that he/she is too great a risk to the Shelter, animals, employees or public.
VOLUNTEER AGREEMENT
In consideration of this opportunity to volunteer, I agree to the following terms and conditions, intending to be legally bound by them.
- I will check in with staff and follow their direction at all times.
- I will notify BMHA should I need to stop volunteering for any reason.
- I will conduct myself with professionalism and respect other volunteers, caretakers, the public and anyone I should come in contact with while performing my duties as a volunteer for Blue Mountain Humane Association.
Release and Waiver of all Claims.
I am about to participate in voluntary care of animals at the Blue Mountain Humane Association. I am doing so entirely of my own free will and initiative and at my own risk and responsibility, with the understanding that some animals I care for are unpredictable and may inflict injury upon myself. I assume the risk of being bitten, scratched, injured, or frightened by cats and dogs in connection with my volunteer works for BMHA.
Blue Mountain Humane Association is not liable for any injuries, damages, liabilities, losses, judgments, costs, or expenses whatsoever, which I might suffer or sustain in connection with the performance of my volunteer activities for BMHA.
I will indemnify and hold BMHA harmless from and against any claims, lawsuits, injuries, damages, losses, costs or expenses whatsoever, sustained by my volunteer experiences. __________________________________ __________________________
Signature Date