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


Name and address

Enter name and mailing address



Preferred Phone number


Emergency Contact

Please enter a contact in case of emergency



Demographic Information

  If you are a volunteer under 18 years of age, signature from a parent or guardian is required.  



Reason for Volunteering and Previous Experience

Please note your reason for volunteering with HSW and any applicable experience you have with volunteering or other skills and abilities. 




Opportunities

Please list the areas you have an interest in as a volunteer.  Note that some roles require orientation or training.   If you want to do something not listed, please explain.



Reference

Please provide a reference of someone who can speak to your abilities as a volunteer. Do not list a family member.



Availability

Please note days you will be available to volunteer. 



History Questions

Have you ever been convicted of 

  1. Animal Cruelty
  2. A sexual offence
  3. A drug or alcohol offense 


Media Release and Hold Harmless Agreement


Hold Harmless and Media Release

As a volunteer of the Humane Society of Wickenburg (HSW), I understand that the sharing of information (including but not limited to photos, videos, or confidential information) is not permitted to be shared on or off the premises without prior approval from HSW.  HSW encourages volunteers to use social media and word-of-mouth in a way that does not produce adverse consequences.  I agree to uphold the goodwill and reputation of HSW among its customers and the community.  I give my permission to HSW to us my photo or videos I am in, in any and all media, at any time.  

I certify that the information provided on this application is true, and I recognize that any falsification of information requested may result in losing volunteer privileges. I authorize investigation of all statements in this application and understand other outside sources may be contacted. I understand that volunteering may be delayed until such information can be verified. Upon submitting this application, it becomes sole property of the Humane Society of Wickenburg.  The information in this document is confidential and will be kept in the strictest confidence. 

HSW reserves the right to deny volunteer privledes to anyone based upon this application and/or investigation of additional information for any reason. I understand that HSW makes decisions in the best interest of the animal. As an HSW volunteer applicant, I understand that I will be interacting with and handling animals.  I understand that in handling animals I may undertake any number of risks. I understand that in assuming this I may be exposing myself to potentially significant health risks or serious medical conditions, including, but not limited to: injuries from bites and scratches, slips or falls, infectious diseases, parasites, and allergic reactions (e.g. rabies, fleas, ringworm, allergies, and asthma). Since many animals that come to the HSW are from unknown backgrounds and are therefore ultimately unpredictable, I am thus aware that HSW is not in a position to know and makes no representations with the temperament, health or condition of any animal in particular.  I must rely on my own judgment and I understand and agree that by handling the animal, as a volunteer I do so at my own risk.  Therefore, I agree to hold harmless, the Humane Society of Wickenburg, its employees, volunteers, agents, or directors, whether collectively or individually, for any injury or liability the animal(s) may cause to me.