Michiana Humane Society

Please complete this application form if you are interested in becoming a Michiana Humane Society volunteer. Once you complete the form, click the Continue button at the bottom.

Volunteer Info

First name:

Last name:

Street:

City:

State:

* Zip: *

Home phone:

Work phone:

Cell phone:

Email address:

Date of birth:

Age:

Gender:

T-Shirt size:

How did you hear about us?:

Preferred Contact:

Do you own a pet?:

If yes, what type and from where?:

Occupational Information

If you are currently employed please share your employer's name, job title, and hours per week. If you are currently enrolled in school please list the school name, your major, and hours per week.

Volunteer Experience with MHS

Have you ever volunteered for MHS?

Yes I have volunteered for MHS.:

No, I have not volunteered for MHS:

If you answered yes, when? What were your duties, and why did you stop?

Other Volunteer Experience

Have you ever volunteered anywhere else before?

Yes:

No:

If yes, when? For how long? What were your duties?

Community Service

Are you planning to volunteer as a commitment to a Community Service assignment? If so, please indicate why you are completing community service.

Community Service:

Academic (Club, Scholarship, etc)

Court-Order (non-violent offenses only)

Organization (Church, Employer, etc)

Volunteer Activity & Preferences

Please check any and all areas that interest you!

What do you want to do the most and why?

Availability

Please indicate the days and times you are usually available to volunteer.

Restrictions

Are there any restrictions that may affect your ability for volunteer work? (i.e. family, work schedules, health restrictions, transportation, etc)

Allergies

Do you have any allergies to animals (OR AT ALL) that we should be aware of? If so, what are they?

Emergency Contact Information

We must have someone to call in case you are injured while volunteering at the Michiana Humane Society. Volunteers under 16 years old must have a parent on site while volunteering.

First name:

Last name:

Home phone:

Relationship:

Create your Password

Please enter a password that:

Is between 8 and 30 characters long
Contains both letters and numbers.
Contains a combination of both uppercase and lower case letters.

Password:

Confirm password:

Volunteer Agreement

Please review the volunteer agreement and click I agree in order to move on. Volunteers under 18 must also have a parental permission form completed.

Agreement, Acknowledgement and Release

In consideration of this opportunity to volunteer, I agree to the following terms and conditions, intending to be legally bound by them:

1. I will abide by the mission, rules, regulations, policies, and programs of The Michiana Humane Society and SPCA while I am a Volunteer.

2. If I stop being a volunteer for The Michiana Humane Society and SPCA for any reason or upon The Michiana Humane Society and SPCA’s request at any time, I will promptly return all of The Michiana Humane Society and SPCA’s supplies, equipment, records, and other items in good, clean condition.

3. I assume the risk of being bitten, scratched, injured, or frightened by: cats, kittens, dogs, puppies, rabbits, guinea pigs, and any other species under The Michiana Humane Society and SPCA’s care in connection with my volunteer work for The Michiana Humane Society and SPCA. The Michiana Humane Society and SPCA is not liable to me 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 The Michiana Humane Society and SPCA unless they are the result of The Michiana Humane Society and SPCA’s gross negligence or intentional misconduct. I indemnify, defend, and hold The Michiana Humane Society and SPCA harmless from and against any claims, lawsuits, injuries, damages, losses, costs, or expenses whatsoever sustained by any companion animal or volunteer activities for The Michiana Humane Society and SPCA, or my breach of The Michiana

Humane Society and SPCA’s rules, regulations, policies, and programs.

4. I understand and agree that The Michiana Humane Society and SPCA may refuse volunteer applications for any reason.

5. If I will be sheltering or providing foster care or boarding of any of The Michiana Humane Society and SPCA’s animals in my home or business, I consent to The Michiana Humane Society and SPCA visiting my home or business from time to time to observe the animals and their living quarters and level of care.

6. I have accurately and truthfully completed this Volunteer Application and Agreement.

7. Any modification to the agreement must be in writing, signed by both parties.

8. This agreement is binding between The Michiana Humane Society and SPCA, me, and The Michiana Humane Society and SPCA’s and my respective heirs, successors, assigns, executors, and personal representatives.

Acknowledgement and Release:

I understand that there is a potential risk in volunteering with an animal or animals. Those risks include but are not limited to injury to myself or others interacting with the animal(s) or to personal property due the unpredictable nature of animal behavior. On behalf of myself, my heirs, personal representatives and assigns, I hereby Release, Discharge, Indemnify, and Hold Harmless the Michiana Humane Society, it’s directors, officers, employees and agents from any and all claims, causes of action and demands of any nature, whether known or unknown, arising out of or in connection with my volunteer activities.

I Agree