Most fields are required.

Personal Information

Name

Date of Birth

Address

City

Zip Code

Home Phone

Mobile Phone

Email

Emergency Contact (name and phone)

Your History with Animals

Pet owning history: what kind of pets have you owned, and for how long? Check if you have volunteered or worked professionally with animals before

In what capacity?

How Would You Like to Volunteer?

How often would you like to volunteer?

Once per week   Twice per week   Special events, as needed   Other (please explain below)

Check if you are able to make a commitment for 4-6 months

If no, how long will you be available to volunteer with us?

Schedule

Please check each approximate shifts that you are available to volunteer. Please DO NOT circle any shift that you would not realistically be able to commit to. Please note that not all shifts are available for all programs.

Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
9-11am	8-11am	8-11am	8-11am	8-11am	8-11am	9-11am
1-3pm (Full)	1-3pm	1-3pm	1-3pm	1-3pm	1-3pm	1-3pm (Full)
7:30-9pm	7:30-9pm	7:30-9pm	7:30-9pm	7:30-9pm	7:30-9pm	7:30-9pm

Please indicate your first and second shift preferences: Preferred type of work Kennel    Community Outreach and Fundraising Both

Check if you have have any animal or chemical-related allergies that may impact your volunteering

Please explain:

If you have any special skills, training or certification that you think would be helpful to the Shelter and our animals, please tells us more:

Liability Waiver and General Release

In consideration of the opportunity for Volunteer to work at Shultz’s Guest House of Dedham, Massachusetts (the “Shelter”), Volunteer agrees and consents as follows:

• Volunteer shall assist the Shelter in the care of pets and miscellaneous tasks, for no compensation.
• Animals can be unpredictable, and sometimes an animal may bite or scratch a person, or transfer a parasite.
• Non-animal-inflicted injuries may also occur at the Shelter.

Knowing and accepting these risks, the undersigned hereby releases and agrees to hold harmless and indemnify the Shelter from any and all actions, claims, or causes of action arising out of or in connection with Volunteer’s presence and/or Volunteer’s assigned or unassigned activities at the Shelter, arising in any manner whatsoever, including personal injuries or property damage which may be suffered by Volunteer whether or not arising out of any negligence or breach of duty by or flowing from the Shelter, or its agents or its employees.

It is further agreed that there are no collateral or outside agreements of any kind between the parties.

Check to acknowledge that you have read, understand, and agree to the terms and conditions of the Liability Waiver and General Release