Polk County Humane Society Volunteer & Community Service Application

Emergency Contact Name:

Relationship:

Phone:

Do you have any allergies, medical conditions, or fears you would like PCHS to be aware of?

Is this for court (or CASP) required community service?

Is this for school required community service?

How many hours of community service do you have to complete?

How did you hear about PCHS?

Why are you interested in volunteering?

Please list any days and times you are typically available to volunteer.

What is your preferred animal?

Are you interested in being a short-term or long-term volunteer?

Please list any present or past volunteer experience:

Please list any prior experience with animals:

Do you have any of the following relevant skills/ experience? (Please check all that apply)

Field of Interest?

Policies and Procedures:
- When the manager is not present, volunteers must report to on-site staff.
- Volunteers must sign in/out at the front desk.
- Volunteers must adhere to dress code.
+ Closed-toe shoes
+ No offensive graphics or messages
+Pants (jeans or khaki) that fall below the knee
- Volunteers must be able to lift 50lb, bend, stoop, and stand for long periods of time.
- Volunteers are expected to behave and communicate respectfully and professionally with shelter staff, fellow volunteers, customers, and animals.
- Volunteers are expected to ask for tasks if none have been previously assigned.

Volunteer Agreement and Release:
1. I verify that I am over 16 years of age.
2. I understand I will be volunteering at my own risk. PCHS, its employees or affiliates, do not assume any responsibility or liability for any personal property damage, accident, injury, or health problems which may arise from any volunteer work I perform.
3. As a PCHS volunteer, I agree that all work I perform is on a voluntary basis and I am not eligible to receive any monetary payment or rewards.
4. I agree that I am not volunteering as part of any court-appointed or teen court-appointed community service program.
5. I agree that Polk County Humane Society and its agents may take photographs or video footage of me for use in public relations efforts, with or without prior notification.
6. I understand and agree that PCHS reserves the right to refuse my volunteer services at any time and dismiss me from the PCHS premises for any reason.
7. I understand that once I have scheduled volunteer hours with PCHS, I am committing to show up to volunteer on time, as scheduled. I understand that PCHS is a non-profit who relies on dependable volunteers. If I "no-call, no-show" more than one time, I will be dismissed as a PCHS volunteer.

Please type your name below as your electronic signature.