VOLUNTEER RELEASE FORM

IF YOU NEED TO PERFORM COMMUNITY SERVICE FOR SCHOOL OR COURT, PLEASE CLICK HERE TO FILL OUT THE PROPER FORM.

Name: 

Address: 

City:  State: 

Zip: 

Your 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 (including area code): 

Work phone (including area code): 

Is it OK to contact you at work? 

Days and times available to help:

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

If yes, please explain:

Physician: 

Physician phone number (including area code): 

In case of emergency notify:  (name of person) 

Relationship: 

Emergency Contact Home Phone (including area code): 

Emergency Contact Work Phone (including area code): 

Current Occupation: 

Employer Name: 

Previous Volunteer Experience:

Is your volunteer work for COMMUNITY SERVICE?

If yes, what's the COMMUNITY SERVICE for? (In order to get credit for graduation or court-ordered service,
please explain what the community service is for
.)

How will you be volunteering?         

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?

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 list the areas you would like to help in the space below.

Socializing animals at the shelter (walking dogs, playing with cats, grooming dogs or cats)

Cleaning kennels at the shelter

Cleaning cat cages at Petsmart

Pet Bank Route (picking up our pet banks at local businesses)

Animal Adoption Bulletin Boards (changing information on our adoption boards at businesses)

Outdoor upkeep (mowing the lawn, weeding, painting, etc.)

Light Housekeeping (dusting, cleaning the office space and public areas in the shelter and thrift stores)

Office Duties (including thank you notes, Happy Tails Scrapbook, filing paperwork, posting adoption information on websites)

Thrift Store help (sorting clothes, picking up furniture)

Helping with Special Events (including fundraisers, Dog Adoption Days at Petsmart, Offsite Adoptions at various businesses)

Please list all the areas (from above) where you'd like to help:

Do you have any other skills you think could assist CVAS?

***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.

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.

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