First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Volunteer Application and Agreement

Birthday*

Occupation*

Special interests (ex. Excel, Web Design, photography, writing, etc.)

Do you have dogs and/or cats? If so, please list your pets.

Are your pets current on their rabies vaccinations?

Are your pets current on other vaccinations appropriate for cats & dogs (e.g. Parvo, Distemper etc.)?

If you have children who would like to volunteer with you, please list their names and ages.

Please indicate one or more activities which interest you:

If other was selected, please specify

As a volunteer I/we understand there are certain risks in working with animals and agree to follow directions/instructions provided by an experienced volunteer(s), perform tasks prescribed by PAWS, and will at all times use caution in performing activities/duties assigned. Volunteers under 16 must be accompanied by their parent/guardian and remain supervised. I agree to hold PAWS of Hertford County, Inc., any of its business partners (i.e., PetSmart), and other volunteers harmless for any claim(s) of injuries, etc. that might arise in the performing of activities/duties.

Do you understand the risks as mentioned above? Please respond yes or no, enter name and date*

Signature of Applicant______________________________ Date__________

Parent/guardian signature (required for student volunteers who are under 18). As the parent/guardian of the volunteer, I agree to allow him/her to volunteer with PAWS and agree to hold PAWS of Hertford County, Inc., any of its business partners (i.e. Petsmart), and other volunteers harmless for any claim(s) of injuries, etc. that might arise in the performing of activities/duties. By signing below, I agree to accompany and supervise him/her if under 16, or grant my permission that he/she can volunteer if 16 or over.

Printed Name of Parent/Guardian (for those under 18 years)

Parent/Guardian Relationship (for those under 18 years)

Signature of Parent/Guardian (for those under 18 years) _____________________________________ Date __________

In case of emergency, please provide an Emergency Contact, a phone number, and the relationship of the contact to the volunteer (for those under 18):

PAWS agrees to hold harmless any claim that might arise against any volunteer(s) who is acting in an official capacity on behalf of PAWS. The PAWS executive board must be notified in advance and provide authorization for any activity(ies) or volunteer actions on behalf of PAWS. Said volunteer(s), regardless of any position held within the PAWS organization, must perform the activity(ies) in an appropriate and legal manner. This agreement can be terminated at any time by PAWS or the volunteer.

Verified and accepted by

PAWS Board Member________________________________Date_________

PAWS Board Member________________________________Date_________