Please complete this application form if you are interested in becoming a Cedar Valley Humane Society volunteer. All blanks with an asterisk (*) are required.



Each volunteer needs a separate application and SEPARATE EMAIL ADDRESS FOR EACH APPLICATION, so if you are volunteering with a spouse, minor (8-16 years old), family member, etc., please return to this page to fill out those additional forms.


Once you complete the form, click the submit button at the bottom.




Name and address


Demographic Information

The following information is used only to help us get a better idea of the demographic make-up of our volunteers.



Volunteer Relationships

If you will be volunteering with someone else (such as a parent, minor, spouse, teacher, client, etc.), please mark those below. Please note that if you are under the age of 16, an adult must volunteer with you.



Employers

The following information is used only to help us get a better idea of the demographic make-up of our volunteer.



Emergency Contacts

Please provide us with at least one emergency contact. Minors (8-17 years old) MUST have two, with one being a non-household member.



References

Please provide two references.



Waiver of Liability and Agreement to Indemnify

THE UNDERSIGNED acknowledges that he/she desires to perform certain services (collectively, the "Services") for the Cedar Valley Humane Society, an Iowa nonprofit corporation ("CVHS"). The Undersigned further understands and acknowledges that certain risks may be associated with performing the Services.

In consideration of being permitted to perform the Services for CVHS, the Undersigned, for himself/herself and his/her heirs and representatives voluntarily and knowingly executes this document and expressly waives any and all rights, claims or causes of action including, without limitation, those involving bodily injury or property damage to the Undersigned, or to the Undersigned's family or property while the Undersigned is engaged, directly or indirectly, in performing the Services, whether or not caused by the negligence of CVHS, its officers, directors, agents or employees.

In further consideration of being permitted to perform the Services for CVHS, the Undersigned hereby agrees to

indemnify, defend and hold CVHS, its officers, directors, agents and employees harmless from and against any and all liability, damage, loss, cost, and expense (including attorneys' fees), incurred as a result of any claim, demand, or cause of action, brought against CVHS, its officers, directors, agents or employees, jointly or individually, for bodily injury of property damage suffered as a result of the Undersigned's negligent, reckless or willful act or omission in the performance (or failure to perform) of the Services.

Due to the nature of the work, volunteers may encounter confidential information in the computer system, on printed documents, or in conversations between employees, volunteers and customers. Each CVHS employee and volunteer is required by law to protect the confidentiality of any person’s identity, address, phone number, and/or personal details from all who don’t have a legitimate reason and authorization for the information. In addition, CVHS seeks to protect the privacy of individuals that are customers, donors, adopters or potential adopters of CVHS.

Failure to protect such information is a violation of CVHS policy and could result in disciplinary action, including termination as a volunteer as well as criminal, civil and/or civil rights liability.

The Undersigned has read and fully understands the contents of this Waiver of Liability and Agreement to Indemnify.

This Waiver of Liability and Agreement to Indemnify shall continue in full force and effect until terminated in writing and in the event of such termination shall remain applicable to all matters occurring or first arising on or before the date of such termination regardless of such termination.