VOLUNTEER RELEASE FORM

Name: 

Address: 

City:  State: 

Zip: 

Your email address:

Date of birth of person wanting to Volunteer: ** 

**Anyone under 18 years old cannot walk the dogs, but can accompany someone 18 and over who will hold the leash.

Home phone (including area code): 

Please list TIMES you are available to help each day (Please Keep in Mind: All of our volunteers are scheduled for days to come in so we may prevent overcrowding and so we know what help we will have on specific days/times.):

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): 

Previous Volunteer Experience:

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.

1. Pet Smart, Norland Ave. Chambersburg: cat cage cleaning

2. Petco, LWW, Chambersburg: cat cage cleaning

3.  Shelter:     cat cage cleaning, dog kennel cleaning, walk dogs, socialize dogs, groom dogs, front desk greeter, laundry, office assistance         

4.  Shelter Grounds (seasonal):      mowing, weeding, mulching

5.  Thrift Store, 66 So. Main Street Chambersburg:     sort clothing donations, light housekeeping, help with furniture donations 

6.  Other:       Special Events & fundraisers, off-site adoption events   

Please list all the areas (from above) that interest you:

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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