Volunteer Application

Please list the full name and date of birth of any youth volunteers:

Street Address(required)

E-mail Address(required)

Cell Phone #(required)

Do you use text messaging?(required)

Yes No

Preferred method of contact

Phone Call Text Message E-mail

Are you affiliated with an organization that coordinates volunteers? (i.e. Typical Life, Focus Behavioral Health, etc…)(required)

Yes No

If yes, please list the organization:

Are you employed by this organization?

Yes No

Do you have health insurance?(required)

Yes No

Do you have any pets?(required)

Yes No

Are they spay/neutered?(required)

Yes No Not Applicable

If no, please explain:

Are your pets current on vaccinations?(required)

Yes No Not Applicable

If no, please explain:

Would you like to receive e-mails about the Shelter's events?(required)

Yes No

Which store locations are you available to volunteer at?

Petco (Route 30) Cape Horn Incredible Pets (Red Lion) Pet Supplies Plus (Shrewsbury Commons) Petsmart North Hanover Ritz & Company Pet Grooming (Spring Grove)

What days/times are you available to volunteer?

Are you interested in other volunteer opportunities?

Events/Fundraising Fostering

If you are interested in fostering, do you rent of own?

Rent Own

If you rent, please provide your Landlord's name and phone # (we will contact your landlord to verify that you are permitted to foster):

If you are interested in fostering, please provide the name and phone # of your Veterinarian:

If you are interested in fostering, please list the name and phone # of TWO personal references (not living in the same household):

I hereby agree that myself and all individuals listed under youth volunteers are providing volunteer services to Heavenly Paws Animal Shelter, Inc., by assisting in pet adoptions, pet cleaning, pet care, and event help. This may include assisting at various off-site locations. I understand that neither Heavenly Paws Animal Shelter, Inc. and/or any of the event/satellite locations are responsible for any illness or injury caused by any animal that I, or any individuals listed under youth volunteers, come into contact with during volunteer work. I agree to hold harmless and release from liability Heavenly Paws Animal Shelter, Inc., and all off-site locations, should I, or any individuals listed under youth volunteers, become sick or injured from any animals, and/or any other type of injury or incident, as a result of volunteer work. I acknowledge that if I do not have health insurance coverage I am aware and agree that Heavenly Paws Animal Shelter, Inc. and/or the event/satellite locations are not responsible for the payment of medical bills or lost wages for any injuries/illnesses that may result from my volunteer work, or the volunteer work of any youth volunteer listed on this application. This agreement is on behalf of the applicant and all youth volunteers listed on the application.

(required)

Agree Disagree

Heavenly Paws Animal Shelter, Inc. has the right to run a public record criminal background check on applicants if needed.(required)

Agree Disagree

By electronically signing this form, I testify that the all information is correct and true. Providing false information on this form allows Heavenly Paws Animal Shelter, Inc. to deny my application to volunteer. If youth volunteers are included on this application, I am responsible and signing on their behalf as parent/guardian. By signing this form, I give my personal references permission to provide any information Heavenly Paws Animal Shelter, Inc. deems necessary to make a determination regarding my volunteer application.