Please complete this application form if you are interested in becoming a volunteer with the T. Russell Reitz Animal Shelter. Once you complete the form, click the submit button at the bottom.


Name and Contact Information

Please include contact information. If you do not have a landline home phone, enter your cell phone; this number will be used as a log in number later.



Personal Information

A photo ID and nonrefundable $25 fee (for the required shelter volunteer t-shirt) are both required prior to training. You must be at least 18 years old to volunteer without supervision.



Emergency Contact


Background

Have you ever been investigated for any animal-related reason by the Riley County Humane Society, the Riley County Police Department, or the Animal Control Officers? If yes, what was the reason and the outcome of that investigation?



Experience

Please answer the following questions and list relevant education, work, and volunteer experiences. Include any involvement with other animal related organizations or activities.



Volunteer Opportunities

Please indicate which opportunity you are interested in.



Desired Tasks

Please list what tasks you would be most interested in performing. If you do not know, skip this section. Please note these will NOT be the ONLY tasks you do. 



Availability

Please indicate your expected availability. For consistency we like either two hours a week, or eight hours a month. Dependability is important, and we appreciate you choosing to volunteer your time!  



Waiver, Release of Claims, Indemnity Agreement

I understand and agree that I am not an employee of the City of Manhattan and will not represent myself as such.

I hereby further understand and agree;

  1. I agree to comply with all of the City's ordinances, rules and regulations. I fully understand and agree to provide my services to the City of Manhattan as a volunteer in a voluntary capacity and that I agree that I will receive no compensation or benefits for services I provide3.
  2. That I am aware that there may be certain risks involved in providing volunteer services for the City of Manhattan, said risks may include injury or accident to person or property or other loss, and I freely, voluntarily, and wish such knowledge assume any such risks while volunteering my services.
  3. That the City of Manhattan, and its employees, agents and assigns shall not be responsible or liable for any injury damage, loss or expense, either to me or my property incurred while volunteering my services and resulting from any act or omission on the part of any employee, agent, or assign of the City of Manhattan.
  4. For myself, my heirs, executors, administrators, and assigns, to defend, indemnify, release, and hold harmless, the City of Manhattan and all of its employees, agents, and assigns from and against any and all manner of actions, causes of actions, suits, debts, claims, demands or damages, liability or expenses, including attorney's fees, of every kind and nature incurred or arising by reason of any actual or claimed act or omission of mine while volunteering my services to the City of Manhattan, including, but not limited to, criminal acts, claims of sexual harassment, civil rights violations, or relating to alcohol or drug use.
  5. That the City of Manhattan, in its sole and exclusive discretion, may terminate me from my volunteer services, if my work is not satisfactory, if my behavior is inappropriate or offensive, if I am under the influence of alcohol or illegal drugs, if I commit a criminal act, if volunteer services are no longer needed, or for any other reasons that the City deems appropriate.
  6. That the City has my permission to use, for any purpose, any photographs, videotapes, recording or any other record which may contain pictures or recordings of me participating in this volunteer program.
  7. That the information in this volunteer application is true and complete. I understand and agree that false statements, misrepresentations or omissions of information in this application may result in rejection of this application, or dismissal from volunteer services if discovered at a later date. The City of Manhattan is expressly authorized to investigate all statements contained in this application. Further, I understand and agree that volunteer service is conditioned upon the successful completion of an investigation into my criminal and personal background. I hereby authorize, by my signature below, the City of Manhattan to conduct such background investigation, which may include, but are not limited to, police background check, social security number verification, criminal background check, sex offender registry check, Central Registry of Child Protection inquiry, a driving record check, fingerprint check and computer voice stress analysis test, if applicable.
  8. I hereby consent to the release of information about my ability and fitness for volunteer assignment by my former and present employers, schools, law enforcement agencies, and other individuals and organizations to investigators, personnel staffing specialists, and other authorized employees of the City of Manhattan.
  9. I understand and agree that if I choose to transport program participants in any private vehicle, that I must have a valid, unrestricted driver's license, and I must maintain current automobile liability insurance coverage on said vehicle, in accordance with statutory requirements. The City will not provide any automobile liability insurance coverage for said purpose or said vehicle or be responsible for any liability or claim arising there from.

    Volunteers who have a work-related injury, illness or exposure have a responsibility to report the event in writing in the required timely manner:

  10. All occupational illnesses or injuries, regardless of how minor, must be reported to the volunteer's supervisor. The report must be made in writing by completing an Accident/Incident Investigation Report with the supervisor followed by the volunteer submitting the completed form to the City of Manhattan Human Resources Department within the earlies of the following dates:
    1. 30 calender days from the date of accident or the date of injury by repetitive trauma;
    2. If the volunteer is volunteering for the entity against whom benefits are being sought and such volunteer seeks medical treatment for any injury by accident or repetitive trauma, 20 calendar days from the date such medical treatment is sought; or
    3. If the volunteer no longer works for the entity against whom benefits are being sought, 20 calendar days after the volunteer's last day of actual work for the entity.
  11. Volunteers who fail to submit a written report of a work related injury, illness, or exposure in accordance with the above guidelines to the Human Resources Department may have a claim for benefits fully or partially denied for the injury/illness.
  12. All required medical treatment due to a work-related illness, injury or exposure will be coordinated by the City of Manhattan Human Resources Department or Thomas McGee, LLC. Volunteers who seek medical treatment other than that chosen by the City of Manhattan Human Resources Department or Thomas McGee, LLC will do so at their own expense.

I hereby represent that I have carefully read and understand the contents of this document and agree to the terms stated herein. In the even an injury or accident occurs while I am volunteering, I agree that it shall be my sole responsibility to provide insurance coverage or guarantee of financial responsibility. I agree that I am volunteering for the City of Manhattan, and submitting this form and making promises hereunder, under my own free will.

I understand and agree that submitting this application form does not automatically register me as a 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.