Name: 

Address: 

City:    State: 

Zip: 

Email address:

Age of person wanting to Volunteer: ** 

**Any volunteer 15 years and younger MUST be accompanied by a parent at all times. ALL volunteers 17 and under MUST have a Volunteer Release Form signed by a parent or guardian.

Home phone: 

Work phone: 

Is it OK to contact you at work?  Yes          No

Days and times available to help:

Do you have any limitations (heavy lifting, limited walking, allergies, etc.)?

  Yes          No

If yes, please explain:

Physician: 

Phone #: 

In case of emergency notify:  (name of person) 

Relationship: 

Phone # (home): 

Phone # (work): 

Current Occupation: 

Employer Name: 

Previous Volunteer Experience:

What is the reason you would like to volunteer (please check all that apply)?

  Community Service for School                 Community Service Court Ordered

  Help Animals                                        Personal Enrichment            

  Individual Volunteer                               Family Volunteer (for children under 16)

   Group Volunteer

What has been/is your experience with animals?

What do you hope to gain by your volunteer commitment to CVAS?

Have you been ever been convicted of a felony or misdemeanor?

  Yes            No

If yes, please explain:

The following is a list of all the areas in which CVAS needs volunteers to help. Please read over each one and check those with which you would like to help.

  Socializing animals 

   Pet Bank Route

  Cleaning kennels

  Petsmart  

  Helping with special events

   Animal Adoption Boards

  Pet Therapy (adults only)

  Office Duties

  Outdoor upkeep

***Volunteers who would like to socialize animals or clean kennels would need to go through an orientation to learn the rules and regulations of the shelter. If you've checked any of the other boxes, we will contact you to discuss the volunteer possibility further.
 

PLEASE READ THE FOLLOWING SECTION CAREFULLY AND IF YOU UNDERSTAND AND AGREE TO THE TERMS, SELECT THE AGREE BUTTON BELOW AND SUBMIT YOUR APPLICATION.

As a volunteer for the Cumberland Valley Animal Shelter, I hereby knowingly, freely and voluntarily waive my right or cause of action of any kind whatsoever against the Cumberland Valley Animal Shelter, its agents or employees for any injury, illness or disease I might contract or sustain while I am volunteering. I also understand that I am not covered by workman's compensation.

I fully recognize and assume the possible dangers associated with the work of the Cumberland Valley Animal Shelter. I agree to notify staff immediately if I am bitten, scratched, otherwise injured or become ill during my volunteer service.

I will treat ALL ANIMALS with RESPECT and CARE and will follow all shelter rules.

I understand that any time I am working in a volunteer capacity with the Cumberland Valley Animal Shelter, I am acting as representative of the organization and will present myself and behave in an according manner.

I understand that I may be asked to leave the shelter immediately if I violate any of the shelter rules and that my position may be terminated.

THE CUMBERLAND VALLEY ANIMAL SHELTER MAKES NO REPRESENTATIONS CONCERNING ANY ANIMAL'S EXPOSURE TO RABIES OR OTHER COMMUNICABLE DISEASES.

   I agree to the above statements, terms and conditions on becoming a volunteer with CVAS.                                

**Please note that by clicking the "I agree" button and then pushing submit, you are providing the electronic equivalent of your signature.