VOLUNTEER - Susie's Hope

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Skills, training, interests, hobbies, etc. pertinent to pets or animals

Please outline any previous or current experience in working with animals?

What interests you about Susie's Hope and its mission?

References

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Susie’s Hope/Susie’s Hope Rescue Waiver and Release

My services to the Susie’s Hope and/or Susie’s Hope Rescue (SH) are provided strictly in a volunteer capacity, and without any express or implied promise of salary, compensation or other payment of any kind whatsoever. My services are furnished without any employment-type benefits, including employment insurance programs, workers compensation accrual of any form, vacations or sick time.

I fully understand that SH expects high standards of moral and ethical treatment of animals under its care. I will strictly adhere to these standards in my capacity as a volunteer. I will follow the policies, procedures and safety precautions of SH, and follow the instructions/directions of the SH staff. I understand that SH, without notice, may terminate my services as a volunteer at any time, with or without reason.

I understand the potential safety risks of working with animals and of bringing home illnesses from the shelter to personal pets. I will practice reasonable health hygiene and adhere to the hygiene policies of SH. I will not bring unapproved guests or family members to SH while I am on duty. I understand that the handling of animals as well as other SH volunteer activities may place me in a hazardous situation and could result in injury to me and/or my personal property.

On behalf of myself, my heirs, personal representatives and assigns, I hereby release, discharge, indemnify and hold harmless the Susie’s Hope, Susie’s Hope Rescue and its directors, officers, employees and agents from any and all claims, causes of actions and demands of any nature, whether known or unknown, arising out of or in connection with my volunteer activities on behalf of SH.

I understand that because I, or my child (if applicant is younger than 18) may handle animals, it is important to discuss being vaccinated against tetanus with my physician. I release the Susie’s Hope/Susie’s Hope Shelter from all responsibility that may occur because of my not pursuing this matter further and I understand whatever decision I make is at my own risk.

Have you received a tetanus shot?

Radio Description

Date Receieved?

In the event of an emergency, I hereby give the Susie’s Hope/Susie’s Hope Rescue permission to seek medical attention for me or my child (if applicant is younger than 18).

Name of Primary Doctor

Phone

I acknowledge and understand that as a volunteer of the Susie’s Hope/Susie’s Hope Rescue, I or my child (if applicant is younger than 18) is not covered by the Susie’s Hope/Susie’s Hope Rescue workers’ compensation or any other insurance policy for any damages or injuries I or my child may sustain during volunteer activities.

I give permission for the Susie’s Hope/Susie’s Hope Rescue to photograph me or my child for use in any Shelter publication for educational or advertising purposes the Shelter may designate.

Volunteer Signature

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Parent/Guardian Signature

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