Volunteer Application Form

Please complete this application if you are interested in becoming an SPCA of Brevard volunteer.

Volunteers must be at least 16 years of age to work alone. Children aged 10-15, may volunteer with an adult.

All volunteers must be at least 16 years of age to work with dogs.

PLEASE NOTE: If you are fulfilling court-ordered community service, please call Debra Cantwell at 567-3615, ext. 240. Do not fill out an application.

You MUST add SPCAVOLUNTEER@SPCABREVARD.COM and MAILER@VOLGISTICS.COM to your contact list so that our email will not be blocked as spam, as all our correspondence is by email. Once you complete the form, click the submit button at the bottom.

Contact Information
If you do not have a home phone or a cell phone, just enter ones in the field, as both fields must be completed in order to submit the application.

First name:	*
Last name:	*
Title:
Nickname:
Street 1:	*
Street 2:
City:	*
State:	* Zip: *
Home phone:	*
Work phone:	*
Cell phone:	*
Email address:	*

Demographics
You must provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:	*
Gender:	*
T-Shirt size:	*
School:

Where You Want to Volunteer?
Would you prefer volunteering at Titusville Thrift Store, Merritt Island Thrift Store, Melbourne Mall Cat Adoption Center, Merritt Island Mall Cat Adoption Center, or the Titusville Adoption Center?

Experience and Special Interests
In what areas do you feel you have moderate to excellent skill or experience? Do you have any special interests or restrictions?

Availability
Please indicate the days you are usually available to volunteer.

My availability is:

Emergency Contact
In the event of an emergency whom should we notify?

First name:	*
Last name:	*
Title:
Street 1:	*
Street 2:
City:	*
State:	*
Zip:	*
Home phone:	*
Work phone:	*
Cell phone:	*
Email address:	*
Relationship:	*

Employer
Please list your current or most recent employer.

Employer name:	*
First name:
Last name:
Title:
Street 1:
Street 2:
City:
State:
Zip:
Work phone:	*
Email address:

EMail
We keep volunteers informed of important news, schedules, and volunteer opportunities by email. It is REQUIRED that you add SPCAVOLUNTEER@SPCABREVARD.CO, and MAILER@VOLGISTICS.COM to your contact list so that our email will be received by your system without being blocked as spam.

VIC Net
We provide an online "Volunteer Information Center" (VIC Net) where volunteers may check their schedules, update their information, and receive messages.

VIC Touch
We utilize an electronic clock-in/clock-out system (VIC Touch) at the SPCA Shelter, Mall locations, and Thrift Stores to track your volunteer hours.

I Agree
I understand and agree that submitting this application form does not automatically register me as a SPCA of Brevard volunteer and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I, the undersigned, do hereby agree to release the SPCA North from all liability. I will not hold the SPCA liable for any damage, illness or injury sustained during volunteer work. I, the undersigned, will never institute any action or suite of law against the SPCA, nor institute, prosecute or in any way aid, assist, or participate, directly or indirectly, in the institution or prosecution of any claim, demand, action or cause of action for damages, costs, loss of services, expenses, or compensation for or on account of any damage, loss, or injury either to person or property, or both, whether developed or undeveloped, resulting or to result, known or unknown, past, present, or future, arising out of the condition or operation of the SPCA Adoption Center, the Merritt Island Maal or Melbourne Mall Cat Adoption Centers, or Merritt Island or Titusville Thrift Stores, including but not limited to any damage, loss or injury either to person or property, or both, resulting from contact with and/or the conduct of any animal located at, or in the custody or control of the SPCA. The undersigned volunteer further hereby releases, dismisses, and discharges the SPCA and covenants and agrees to defend, indemnify and hold the SPCA from demands, damages, suits, costs or expenses, said volunteer has or may have for any reason or which may occur or arise by reason of volunteer's association, activity or work now, heretofore or hereafter at or with the SPCA Adoption Center, Mall Cat Adoption Centers, or Thrift Stores.

This signature must be that of the individual "signing" this document electronically or be made with the full knowledge and permission of the individual, otherwise it constitutes forgery under s.831.06, Florida Statutes. The individual "signing" this document affirms that the facts stated herein are true.

I Agree