Form number 0020
Shelter Volunteer Program
Would you like to offer your helping hands to Needy Paws Animal Shelter by becoming part of our volunteer program? Please take a moment to
fill out this form completely.
Date __________________
Age (if under 18) ________________ EMAIL ADDRESS: _____________________________________
Name ____________________________________ Phone number _____________________
Address __________________________________
City/State/Zip _______________________________
Please mark the days and times you are available to volunteer.
_____Tuesday
____________
_____Wednesday
______________
_____Thursday
____________
_____Friday
____________
_____Saturday
____________
Please check the duties you are interested in performing:
_____Clean upstairs
_____Leaf blowing (18+)
_____Foster Care
_____Clean heater closet
_____Brush cats
_____Participate in fundraisers
_____Organize center storage
_____Walk dogs
_____Window washing
_____Bathe dogs/puppies
_____PetSmart Adoptions (Russellville)
_____Kennel cleaning
_____Pick up litter outside
_____Rake leaves
_____Play with cats
_____Clean cat cages
_____Dusting above kennels, under stairway, etc.
Release of Responsibility and Claims
Participation in the shelter’s volunteer program could include animal and chemical contact. Animal nature cannot always be predicted, and
physical injury is always a possibility. Due to this, it is necessary for you to read over the following release and sign prior to volunteering at this
shelter.
In consideration for the benefits which I, or my child, receive from participation in a volunteer program, which is a Humane Society of
Johnson County program, conducted by the board of directors and staff at the shelter, I hereby release The Humane Society of Johnson County,
staff, and directors from any and all action, causes of action, liability and responsibility for personal injury or property damage of all kinds which
might occur to me, my child, or my property, as the result of or arising from participation in the volunteer program.
Additionally, I further agree to hold the released parties harmless from all claims, demands, suits, judgments, including legal expenses and
attorneys’ fees, which arise from or result from participation in the volunteer program, or personal injury or property damage sustained by me, my
child, or my property.
I, the undersigned, , state that my, or my child’s participation in the volunteer program is a voluntary decision on my part.
I, the undersigned, state that I have no medical condition (allergies of animals, etc.) which would affect my participation in this volunteer
program.
I, the undersigned, that I will follow all rules outlined to me by the manager. As a result of not following the rules, I understand that I will
be asked to not return to the volunteer program.
Signature of volunteer __________________________________________
Date ________________
Signature of guardian ___________________________________________
Date ________________
Signature of shelter witness ______________________________________
Date ________________
Revised 1/05