Carleton CountyAnimal Shelter Volunteer Application Form378 Debec Road, Debec NBE7N 3B4(506)277-1104 Name * First Name Last Name Date of Birth * MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone | Home (###) ### #### Phone | Work (###) ### #### Phone | Cell (###) ### #### Have you ever been convicted of an offence under the Animal Cruelty Act? Yes No Have you ever been convicted of any other crime? Yes No Date of last tetanus shot: MM DD YYYY VOLUNTEER CONFIDENTIALITY AGREEMENT Any information you may see or hear pertaining to Carleton County Animal Shelter issues, records, or cases is confidential. At all times, privacy and dignity of the animals, clients, donors, volunteers and staff will be respected. As a volunteer of Carleton County Animal Shelter, you may have access to information and documents relating to animals, clients, donors, volunteers and staff that are private and confidential in nature. All records are the property of Carleton County Animal Shelter and will be treated as confidential material; reasonable care and caution should be exercised to protect and maintain total confidentiality. No person shall read records or discuss such information unless there is a legitimate purpose. Shelter information shall not be discussed with people outside the shelter, including immediate family members. Carleton County Animal Shelter prohibits any temporary or permanent removal of confidential records from the premises. Volunteers are prohibited from discussing any confidential records, cases, or other issues with representative of the media. If a volunteer fails to follow this agreement, the volunteer’s position will be terminated immediately. By clicking "I Agree" I understand the importance of the Confidentiality Agreement, and will abide by it. If I have any questions concerning any of the above issues, I will report to shelter staff or board members. * I Agree Name * Of Applicant or parent/guardian for all minors. Signing of this document will be done at the shelter. First Name Last Name RELEASE AND WAIVER I recognize and acknowledge that working directly with animals entails inherent risks of injury to myself and damage to my property. I understand that all animals are unpredictable in their behaviour, and that there is a risk of injury involved when performing any activity with or near animals. I also understand that there is a risk of contracting and spreading disease to other animals and to people. I am also aware that animals may harbor an illness for a long period of time before showing any symptoms. I understand that there is no medical history on the animals that come into the shelter. In consideration of being permitted to volunteer at the Carleton County Animal Shelter, I agree to assume all risk of loss or injury, including death, to myself or damage to my property while on the premises of the Carleton County Animal Shelter and elsewhere while participating in the volunteer program, and hereby release and waive any right of action against the Carleton County Animal Shelter, their heirs, assigns, agents or volunteers for any such loss or injury, even though such loss or injury is caused by negligence or default of the Carleton County Animal Shelter, its agents or it volunteers, whether acting in the scope of employment or not. I hereby release and forever discharge and hold harmless the Carleton County Animal Shelter from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my activities with the Carleton County Animal Shelter. I understand it is my responsibility to report all injuries or damage to staff if/as they arise. By clicking "I Agree," I acknowledge that I have read this release and have voluntarily accepter it. I acknowledge that the staff present is in full and total charge of the facility. * I Agree Date of Agreement: MM DD YYYY Name of parent/guardian if applicant is a minor Signing of this document will be done at the shelter. First Name Last Name IN CASE OF EMERGENCY CALL Emergency Contact First Name Last Name Emergency Contact Phone | Home (###) ### #### Emergency Contact Phone | Work (###) ### #### Emergency Contact Phone | Cell (###) ### #### VOLUNTEER AGREEMENT I agree: -To follow all commitments and expectations of volunteers -To recognize the risks when working around animals -To be a positive role model in the community on animal care -To communicate clearly any problems or concerns I may have on any issue pertaining to volunteering or the facility -To treat all people and animals equally and with respect By clicking "I Agree" I acknowledge I have read, understand and agree to the above Volunteer Agreement * I Agree VOLUNTEER OPPORTUNITIES AND PREFERENCES Please check ALL areas you would be interested in volunteering in: Cat Cuddling Cat Care (scoop and clean litter boxes, feeding, grooming) Special Events Volunteer (fundraising events, ticket sales, yard sales, other public events) General Maintenance (lawn mowing, snow removal, repairs to the shelter, painting) Board Members Availability * Please check ALL days of the week you will be available to volunteer: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Other: Thank you!
