LHAR Volunteer Application

Date of Birth

Drivers License

If employed, please list employer and occupation

Work History

I am currently or have previously been a member of the United States Military.

I am covered by health insurance with

I do not have health insurance coverage*

*If you do not have coverage, do you understand that expenses from possible injury will be paid by you personally and not by Logan’s Heroes Animal Rescue Inc.?

It is recommended that you are currently vaccinated for DT(Diptheria& Tetanus). Do you have any physical or mental disabilities that would limit your ability to perform certain duties?

If yes, please list

Have you ever been investigated for animal cruelty for any reason?

If yes, describe the circumstances

Including traffic violations, have you ever been convicted of any criminal offense?

If yes, please explain

Have you worked/volunteered with a humane society, rescue/shelter or an animal care facility?

List the name of the facility where you worked/volunteered.

Is your involvement with the organization(s) listed above current?

I am available for volunteering ____hours each week during the following days and times:

for Other please enter in response

Please list three references (mandatory for consideration –only one reference may be a relative)

1 Name Relationship Organization Contact Info

2 Name Relationship Organization Contact Info

3 Name Relationship Organization Contact Info

If I am accepted into the volunteer program, I agree to adhere to the procedures and policies of Logan’s Heroes Animal Rescue Inc. (LHAR) __________(initial)

I also understand that the behavior of domestic animals is at times unpredictable, and that some domestic animals are capable of inflicting property damage, serious personal injury and even death. I am well aware of the risks of handling domestic animals, and with such understanding, I hereby waive, release and forever discharge Logan’s Heroes Animal Rescue Inc.(LHAR) , its employees, agents or trainers, from any and all claims (whether present or future) arising out of my participation in the volunteer program. _________(initial)

(Guardian Signature Required for all Volunteers under 18 Years Old.) I certify that as of today’s date, I am over 18 years of age.______(initial) If under 16, I certify that my guardian* will be with me at all times while I am volunteering for the rescue.___________(initial)

*Guardian’s name:

address

phone:

email:

I (guardian) have completed a volunteer application.____________(initial)

Vaccination of non-shelter pets – To protect non-shelter pets from contracting any potential shelter diseases, and to prevent the shelter pets from developing diseases from non-shelter pets, I certify that all my personal pets are current on their rabies, distemper, bordetella and parvo vaccinations. _______(initial)

Photo Release – I agree to allow pictures of myself to be used, without compensation for the purpose of publicity related to Logan’s Heroes Animal Rescue Inc. _______(initial)

Release of Liability – I fully understand that as a part of my volunteer work at Logan’s Heroes Animal Rescue Inc., I will come in contact with animals either by direct handling or assisting in their care. I further understand that working with animals carries a risk of injury, and it is possible that I may be bitten, scratched, and/or otherwise injured. I also understand that I may be exposed to domestic animal illness and disease and that it isalso possible that I could indirectly expose my own pets to such illness and disease. My signature to this volunteer liability release attests to my intent to hold harmless and release from all liability Logan’s Heroes Animal Rescue Inc., and their agents and assigns from all acts which are related to my performance of any and all volunteer duties. ______(initial)

Advisory – You are strongly urged to have a current tetanus vaccination to protect yourself should you be cut, scratched or otherwise injured in such a way that tetanus infection could threaten your health. _______(initial)

Medical Release: In case of emergency, I authorize Logan’s Heroes Animal Rescue Inc. to arrange emergency medical treatment after attempting to notify the contacts listed below.

name, phone and their relationship to you

name, phone and their relationship to you