Volunteer

Please Fill Out All Required Lines That Have An Asterisk *
Today's Date :
How did you hear about the volunteer program:
Why are you interested in volunteering at CCHS? : *
Are you interested in becoming a Foster? :
Name: *
Address: *
Address (2):
City: *
State: *
Zip: *
Cell Phone: *
Home Phone: *
Email:
Are You 18 Years Of Age Or Older: *
Individuals 15 Years Of Age Or Under Must Be Accompanied By A Parent Or Guardian. The Parent Or Guardian Must Complete The Volunteer Application And Accompany The Individual At All Times
Paren/Guardian Name :
Are you attending as part of a group? (Ex. Aspire, TRC, Scouts, ARC, etc.): *
Individuals attending as part of a group must be accompanied by support staff. The support staff must complete the volunteer application and accompany individuals at all times.
Support staff name :
Organization :
Emergency Contact Name:
Emergency Contact Relationship:
Emergency Contact Home Phone:
Reliability is vital when you commit to becoming a CCHS volunteer. The health and well-being of the shelter animals depends on dedicated volunteers. We ask that you carefully consider the amount of time that you will be able to give to the animals at CCHS.
Is there a reason you believe you may not be able to consistenly volunteer? :
If No Explain :
If Yes, explain:
What Volunteer opportunities are you interested in? (Please choose 4): *
What time of day are you available? :
How much time do you anticipate being able to volunteer: *
What day(s) are you available? : *
Do you understand that CCHS is a no need to to kill shelter. That means at times we do still euthanize animals if they are not healthy or unable to socialized. We DO NOT euthanize for space: *
Please explain your feelings on euthanasia.: *
Release of Liability and Assumption of Risk. Enter full name on line 1 and initial items 2-7 acknowledging you have read and understand each item of this Release of Liability and Assumption of Risk.
1) I hereby acknowledge that if I am accepted as a Chautauqua County Humane Society (CCHS) Volunteer, I agree to comply with all of the rules, agreements, and protocols which may be established from time to time by CCHS. I understand that failure to comply with the rules, agreements, and protocols may result in my termination as a volunteer. (type full name): *
2) I understand the importance of being reliable and consistent for the betterment of the animals at CCHS. Should I find the nature of this volunteer work is not what I expected, or I can not fulfill my commitment I will contact the volunteer coordinator so that my volunteer records can be updated and pulled from the program. (Please enter initials): *
3) I understand and agree that if accepted as a volunteer, all services performed by me will be performed on a strictly voluntary basis, and that I will receive no pay or compensation of any kind, that I will not be an employee of CCHS nor otherwise derive any benefits available to employees of CCHS. (Please enter initials): *
4) I authorize CCHS to seek medical treatment in case of an accident, injury or illness. I understand that I will be working with animals with unknown and unpredictable characteristics and dispositions, and will be subjecting myself to various work conditions. I hereby assume the risk of injury that may result from my volunteer services and am aware that my own health insurance coverage will provide for any necessary medical treatment or care. (Please enter initials) : *
5) I understand that CCHS recommends that all volunteers maintain current tetanus vaccinations if they will be handling animals and that I have been encouraged to consult a physician to determine whether or not to be vaccinated against tetanus at my own expense. (Please enter initials): *
6) I am aware that volunteering for CCHS can be a potentially hazardous activity. I understand and acknowledge that CCHS is a charitable, non-profit organization. I hereby waive, release and discharge any and all claims of damages for death, personal injury or property damage which I may have, or which may hereafter accrue to me, as a result of my participation as a volunteer for CCHS. This Release of Liability and Assumption of Risk is intended to discharge in advance CCHS, its agents, directors and employees, and any and all volunteers, and their respective successors and assigns, from and against any and all liability arising out of or connected in any way with my participation as volunteer for CCHS, even though that liability may arise out of negligence or carelessness on the part of the persons or entities above mentioned.(Please enter initials): *
7) I will keep confidential any and all information in regards to any animals or people who access the services of CCHS. I will not take any pictures or put any information about CCHS on any form of social media with out the consent of CCHS. (Please enter initials): *
Volunteer Name : *
Date :
Parents Name(s): *
Once submitted you will be notified of the next volunteer orientation by e-mail.