Ambassador Volunteer Form

Please complete this application form if you are interested in becoming a Rescue Village Ambassador Volunteer. Once you complete the form, click the Continue button at the bottom.


Name and address


Emergency Contacts

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



Therapy Dog Info

*Please submit all certification and vet records to education@rescuevillage.org



Availability

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



Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.



Waiver

WAIVER OF LIABLITY AND PERMISSION FORM

 

In consideration of my participation as an Ambassador volunteer and other activities, the undersigned as identified below hereby agrees to hold harmless, release, waive, forever discharge and covenant not to sue the Geauga Humane Society (hereby hereafter referred to as GHS), its administrators, directors, agents, servants and employees, all of which are hereinafter referred to as “Releasees” from any and all liability to myself along with our heirs, assigns and next of kin for any and all claims demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise. 

It is further agreed that the undersigned is fully aware of the nature and extent of the potential hazards and risks of working with and /or near shelter animals and/or experiences that may arise, and agrees to assume those risks and to release, discharge, indemnify and hold harmless all of the Releasees mentioned above who (through negligence, carelessness or otherwise) might be liable to myself or my heirs or assigns for damages.  The undersigned releases, waives, forever discharges and covenants not to sue the Releasees for any and all loss or damage to personal property that may occur while participating in the Ambassador Volunteer program.

The undersigned hereby grants permission to the GHS to use any photographs or video taken of myself, or artwork created by myself, for use in its public relations efforts.  The GHS has permission to include the my name in materials that promote or publicize GHS services, programs and events, without compensation or notification.   The undersigned understands that they will be participating in activities that may include media coverage, including, but not limited to, television, radio and newspaper.

Geauga Humane Society Tetanus Waiver

TETANUS is a bacterial disease that affects the nervous system. It is contracted through a cut or wound that becomes contaminated with tetanus bacteria. A TD booster shot is recommended every 10 years.   If you experience any break in the skin, (cut, scratch, bite, etc.) you must immediately report the incident to your health care provider.  We strongly recommend that you to be vaccinated against tetanus and to consult your physician concerning the risks of tetanus:

 

I do hereby declare I'm physically able to participate in the volunteer activities for which I/we have applied.  I/we are fully aware that there are physical risks inherent in the care of animals and related activities performed by GHS.  

 

The undersigned hereby grants permission to the GHS to utilize and authorize any medical emergency services it deems necessary for the below-named. The undersigned also understands the risk of tetanus associated with the Ambassador Volunteer program.