3/23/2020 ***Note: Due to the Coronavirus - all new volunteer orientations, Foster Care home visits, and new volunteer training sessions have been put on hold. You can still complete an application and the Volunteer Coordinator will follow-up with you when we are ready to on-board new volunteers again. Please email the Volunteer Coordinator with questions.***

Contact Information

First name:

Last name:

Middle Initial:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Demographics

Date of birth:

Age range:

Gender:

Availability

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

Assignment Preference

The following volunteer assignments may currently be available. To learn more about each assignment, please visit the "Volunteer" tab on the website. Use this list to rank your top three assignment choices.

Please note - volunteers ages 14-17 may apply for the following positions only:
-The After School Program (ages 14-17)
-Baker
-Gardening Gurus (16 years & up)
-ROMP Camp Counselor (16 years & up)
-Small Animals Socialization (ages 14-17 with a parent/guardian)
-Wear Cat Costume at Community Events (14+)

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Relationship:

Employer

Please list your current or most recent employer, if applicable.

Employer name:

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

EMail

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.

Email address:

Volunteer Information Center

We provide an online "Volunteer Information Center" where volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access the online Volunteer Information Center.

Please enter a password that:

Is between 6 and 30 characters long
Contains both letters and numbers.

Password:

Confirm password:

I Agree - Liability Waiver

I understand and agree that submitting this application form does not automatically register me as a Washington County Humane Society 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 also understand that by checking “I agree” I acknowledge that I (adult) or we (both parent/guardian of a minor and the minor) have read the waiver below and state that I understand it and that I am voluntarily signing it without any inducement or representation from any member of the WCHS staff.

ADULT VOLUNTEER WAIVER

I am agreeing to act as a volunteer for WCHS. I acknowledge and agree that activities performed strictly on a voluntary basis, without pay, compensation or benefits. I agree to comply with the rules and regulations established by WCHS and failure to do so may result in my immediate removal as a volunteer. I am aware of the nature of the activities to be performed as a volunteer and I recognize and understand there are certain risks inherent in handling animals and I accept those risks. I agree that all volunteer activities are performed at my own risk. I understand if an accident/injury occurs, no matter how minor, I will complete a Volunteer Injury Report form and seek any necessary medical attention using my own medical insurance. On behalf of myself and my respective heirs and personal representative, I agree to indemnify and hold harmless WCHS, its officers, directors, employees, agents and volunteers from and against any loss, damage, claims, liability, costs and expenses of any nature whatsoever, including but not limited to, attorney’s fees and disbursements arising from or occasioned by my activities as a volunteer for WCHS. I agree that WCHS may use my image for WCHS displays, educational programs and/or other public relations, and I hereby release any such images/photographs for use in its programs, publications and purposes.

MINOR VOLUNTEER WAIVER

I am the parent/guardian of________________________________________, a minor volunteer, under eighteen (18) years of age, hereby consent and authorize______________________ to act as a volunteer for WCHS. I acknowledge and agree that activities performed by my child as a volunteer will be performed strictly on a voluntary basis, without any pay, compensation, or benefits. I agree to comply with the rules and regulations established by WCHS and failure to do so may result in the immediate removal of my child as a volunteer. I am aware of the nature of the activities to be performed by my child as a volunteer and I recognize and understand there are risks inherent in handling animals and I accept those risks. I agree that all volunteer activities performed by my child will be at the child’s risk and I assume full responsibility. Therefore, I understand that if an accident/injury occurs, no matter how minor, my child will complete a Volunteer Injury Report form and seek any necessary medical attention, using my own medical insurance. On behalf of myself, the child, and our respective heirs and personal representative, I agree to indemnify and hold harmless WCHS, its officers, directors, employees, agents, and volunteers from and against any and all loss, damage, claims, liability, costs and expenses of any nature whatsoever, including but not limited to attorney’s fees and disbursements, arising from or occasioned by my child’s activities as a volunteer for WCHS. I agree that WCHS may use my child’s image for WCHS displays, educational programs and/or public relations, and I hereby release any such images/photographs for use in its programs, publications and purposes.

I Agree