Please complete this application form if you are interested in completing Community Service at the Butler County Humane Society. Once you complete the form, click the submit button at the bottom of the page.

Please be aware that BCHS reserves the right to deny any Community Service requests for any reason. If you are approved to complete Community Service we will be reaching out.

Name and Address

First name:

Last name:

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:

Email address:

Date of birth:

Age:

Gender:

Employer name:

Street 1:

Street 2:

City:

State:

Zip:

Work phone:

Contact Information

Please list your phone number.

Emergency Contact

Please list the name and phone number of your emergency contact.

Availability

Please indicate the days and times you are usually available.

Probation Officer Name/Phone Number

Reason for performing community service?

Specify Charge or requirement. We have the right to refuse any applicant based on the charges.

How many hours of community service do you need?

When do you need to complete the hours?

Community Service Waiver of Release

This agreement is between the Butler County Humane Society and a volunteer who is donating services to BCHS. BCHS is a non-profit organization. The volunteer is performing services for BCHS and assumes the risk of damage to body and/or property. I agree to Indemnify and Hold Harmless the Butler County Humane Society, its employees, members, volunteers, agents and the Board of Directors from any and all liability arising out of or in consequence of or injury sustained as a result of any activity connected with myself and the Butler County Humane Society. I also understand that, although unlikely, there is a risk of transmission of the disease, including but not limited to Ringworm, Roundworm, Coccidiosis, Dog Tapeworm, Toxoplasmosis, Rocky Mountain spotted fever, Cat-Scratch fever, and Rabies, while working in an animal shelter. I agree to Indemnify and Hold Harmless the Butler County Humane Society, its employees, members, volunteers, agents and the Board of Directors from any and all liability arising out of or in consequence of or injury sustained as a result of any activity connected with myself and the Butler County Humane Society.

To comply with the order for completion of community service, the Butler County Humane Society is given the authority to oversee your work and direct your activities during the time you are scheduled at the shelter. You are expected to:

-Maintain a good attitude

-Respect staff, volunteers and general public

-Maintain a record of your time

-Perform your assigned duties

-Report for your shift and to your supervisor on time. If you are unable to make your scheduled shift and do not call, after the third occurrence you will be dismissed

-You are NOT permitted to walk or take animals from the building unless you have completed volunteer orientation, which is different from regular community service

-BCHS does not guarantee the availability of service hours to meet court ordered deadlines

Failure to disclose any information or misconduct will result in immediate dismissal!

I Agree