Mutley's Miracles Volunteer Application

Volunteer Information
Name___________________
Address:_________________________________________________________
Home Phone:____________________ Work Phone:______________________
Email:__________________________

Emer!ency "ontact
In an emer!ency# please notify:_______________________________________
Phone:__________________

Interests
"heck all that apply:
o Walkin! do!s
o $acility Maintenance
o administrati%e &ork
o $undraisin! acti%ities
o $oster "are
o 'ard &ork
o (ri%ers
o Pu)lic Information and net&orkin!
o *ther:____________
Volunteer A!reement
In consideration of this opportunity to %olunteer for Mutley's Miracles# I# ___________________#
a!ree to the follo&in! terms and conditions# intendin! to )e le!ally )ondin! to them:

o I &ill a)ide )y the mission# rules# re!ulations# policies and pro!rams of Mutley's Miracles and
+hansumako $arm &hile I am a %olunteer,
o My primary customers are the -animals. at the shelter and their &ell)ein! and humane treatment are
foremost in the performance of all Animal +helter %olunteer acti%ities,
o I &ill not en!a!e in any unsafe# ille!al# or unethical acti%ities &hile ser%in! as an Animal +helter
%olunteer,
o As a condition of %olunteerin!# &hich I ackno&led!e to )e ade/uate consideration# I also a!ree to
hold Mutley's Miracles# +hansumako $arm# 0escue 0iders# 1atharine "lark# (e))ie Phillips and it's
)oard of directors harmless and enter into and additional &ai%er of lia)ility contemporaneously
&ith this Volunteer a!reement,

2he a)o%e conditions ha%e )een re%ie&ed &ith me and I understand that failin! to uphold them is
sufficient !rounds for Mutley's Miracles and +hansumako $arm to re/uest and implement my remo%al
as a %olunteer,

Volunteers si!nature________________________ (ate:____________

______________________________________________
+i!nature of Parent34uardian5 if %olunteer is under the a!e of 67 years8
9ia)ility 0elease Wai%er
6, I reco!ni:e that &hile performin! my ser%ices in a %oluntary capacity# in handlin! animals, there
e;ists a risk of in<ury# includin! physical harm to me, *n )ehalf of myself# my heirs and personal
representati%es# I here)y release# dischar!e# indemnify and hold harmless the Mutley's Miracles#
+hansumako $arm# 0escue 0iders its =oard of (irectors# a!ents# ser%ants and employees from any and
all claims# causes of action or demands of any nature or cause connected &ith my %olunteer ser%ice,
2his mi!ht include costs# attorney>s fees# and courts costs incurred )y the =arn&ell "ounty Animal
+helter in connection &ith my %olunteer ser%ices )ased on dama!es or in<uries &hich may )e incurred
or sustained )y me in some &ay in the prosecution of the %olunteer &ork, +uch dama!es or in<uries
mi!ht include# )ut are not limited to animal )ites# accidents# in<uries# or personal property dama!e,
?, I also a!ree to release# dischar!e# indemnify and hold tMutley's Miracles# +hansumako $arm# 0escue
0iders harmless for any and all dama!es to my personal property &hile performin! my ser%ices to the
Mutley's Miracles in a %oluntary capacity,
@, If I am si!nin! this release form as a parent or le!al !uardian of a minor %olunteer 5under 67 years of
a!e8# I here)y !i%e my consent to allo& my child 5&ard8 to %olunteer ser%ices for Mutley's Miracles#
+hansumako $arm# and 0escue 0iders, I understand that such a minor child is not co%ered )y the
a!ency>s &orker>s compensation or lia)ility policy and I a!ree to hold Mutley's Miracles harmless for
any claim# loss or dama!e incurred )y such child,
A, I ackno&led!e that I ha%e read and fully understand the terms and conditions of the fore!oin!
lia)ility release &ai%er,

I# # understand that I am askin! to )e allo&ed to %olunteer my time at Mutley's Miracles, I understand
that I &ill )e &orkin! &ith stran!e# &ild# a)used# and3or scared animals that are stran!ers to me and I to
them, I fully understand that there are many risks in%ol%ed in handlin! these animals,
I ackno&led!e that it has )een e;plained to me that any animal has the potential to hurt# )ite# scratch#
maul# disfi!ure# and e%en kill a person,
2herefore# I# # do a!ree to assume all risk of in<ury or harm to myself or to my property and
a!ree to release# indemnify# defend# and fore%er dischar!e Mutley's Miracles# +hansumako $arm# and
0escue 0iders and its staff# employees# and a!ents of and from any lia)ility# claims# demands# costs#
e;penses# actions# and causes of action 5collecti%ely# the -"laims.8 in respect to death# in<ury# loss# or
dama!e to myself or my personal property# ho&soe%er caused# arisin! or to arise )y reason of my
%olunteerin! at Mutley's Miracles# +hansumako $arm and 0escue 0iders,
Volunteer>s +i!nature:________________________ (ate:____________________
______________________________________