Volunteer Application | Clay County Kansas Animal Rescue & Education Center, Inc

Name *

Cell Phone *

E-mail *

Address *

Please include street, city, state, and zip

If you have not held residency at the above address for 5 years - provide your previous address

Date of Birth *

Month

Day

Year

Gender *

Male

Female

Would you like to receive email and/or text message notifications from CCARE? *

Yes

Employer *

Work Phone *

Yrs Worked There *

** A COPY OF YOUR PHOTO ID IS REQUIRED UPON VOLUNTEER APPROVAL**

Do you have a driver's license? *

Yes

License Number *

If yes, what was the reason and outcome?

Have you ever been convicted of a felony? *

Yes

If yes, please explain. Please be truthful, we reserve the right to conduct a criminal background check.

Have you ever had (or currently have) a problem with drugs and/or alcohol? *

Yes

If yes please explain

Are you involved with any other animal related activities or organizations? *

Yes

If yes please list

Do you accept and understand that in the case of an animal that is determined to be vicious by CCARE or a municipal or district court, the ncessary disposal of that animal by euthanasia will be done through this organization? *

Yes

Can you handle being around public members who can be angry or abusive *

Yes

If you have any physical limitations (i.e. allergies, back proglems, heart conditions, health conditions) that would prevent you from participating in certain activities - please explain

List any formal training, education, skills, or experience in pet care or animal welfare that you possess

Mark your CCARE volunteer interests below (all are unpaid volunteer activities).

Other Interests - please explain

If you currently have a pet, who is your primary Veterinarian?

Your Emergency Contact Information

Contact Name *

Their Address *

Please include street, city, state, & zip

Best way to reach them *

If phone number, please list if it is home, cell, or work.

Availability to volunteer - type your availability during the week (mornings, afternoons, and/or evenings).

Please be as specific as possible so we know when to contact you. If you can list specific times for each day, that is preferred.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Please indicate your t-shirt size (unisex) *

VOLUNTEER AGREEMENT (READ CAREFULLY)

In understand that the abbreviation “CCARE” represents Clay County Animal Rescue & Education Center, Inc., its Board of Directors, Members and paid Staff.

I certify that the answers given by me to all questions on this application and any attachments are, to the best of my knowledge and belief, true and correct, and that I have not knowingly withheld any pertinent facts or circumstances. I understand that any omission or misrepresentation of fact in this application may result in refusal of or separation from volunteer service upon discovery thereof.

I authorize CCARE to conduct a criminal background check on me.

I agree to attend necessary training/orientation before doing any volunteer work. I agree to be supervised by Shelter Director or CCARE Board of Directors. I understand that when handling animals there is a risk of injury, exposure to disease, and physical harm. I am aware that some of the animals may not have had their rabies shot. I agree to report any problems relating to animal care, animal behavior, volunteer issues, or shelter issues to the Shelter Director or CCARE Board of Directors. I agree to follow the CCARE Manual concerning policies and procedures, rules and regulations, and understand that failure to do so will result in possible release of volunteer duties. I agree to do all volunteer duties without pay or compensation.

In consideration of my volunteer participation with CCARE, on behalf of myself, my heirs, personal representatives and executors, I hereby forever release and discharge Clay County Animal Rescue & Education Center, Inc., and its Board of Directors, Members, and paid Staff, and any facility where adoption or fundraising events are held, from any and all liability arising from accident, injury and illness that I may suffer as a result of my volunteering. I further agree to indemnify and hold harmless Clay County Animal Rescue & Education Center, Inc., and its Board of Directors, Members, and paid Staff, and any facility where adoption or fundraising events are held, from any and all claims, costs, and attorney fees, resulting from injuries, damages, and losses sustained by me arising out of, connected with, or in any way associated with CCARE volunteer activities. In the event of emergency, I authorize CCARE officials to secure from any licensed hospital, physician, or medical personnel any treatment deemed necessary for me immediate care and agree that I will be responsible for payment of any and all medical services rendered, including all costs, claims and attorney fees.

I understand that as an unpaid volunteer I am NOT covered by Kansas Worker’s Compensation law.

This application is not valid without signature. For emailed registration, signature provided by transmittal will stand as a valid signature and will be held as binding and will represent consent of waiver here within.

Electronic Signature *

By typing your name in this area, you are agreeing to all terms written above.

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