Emergency Contact Information
Emergency Contract Phone Number*
Is the volunteer a minor?*
if YES - give Date of Birth & Age
Medical conditions that we need to be aware of: (or type
What are your interests?
Dog Walking TLC
Medical Helper Triage
Events Committee (offsite)
Admin Helper (onsite)
Cattery Help TLC
Animal Transport (offsite)
Petsmart Cattery (on location)
Maintenance Yard Worker
Thrift Store (on location)
Photography / Video
Technical - web, data, multimedia
Graphic Arts - multimedia
Production - radio, video, multimedia
Have you ever been convicted of a felony (diversion programs/adjunction withheld)?*
List any related skills, qualifications, or volunteer work:
Do you have any pets at this time?*
Are your pets spayed or neutered?
Please Read Carefully:
I give permission to be photographed, interviewed or videotaped to publicize FHS volunteerism. This may be used in newsletters, website or other publications to raise community awareness of our work for the animals. I agree to comply with all rules and regulations that may be established by the Flagler Humane Society. I understand that my failure to comply may result in my inability to volunteer with Flagler Humane Society. I acknowledge that my services are provided on a volunteer basis without any pay or compensation of any type and without liability of any nature on behalf of Flagler Humane Society. All service performed by me are at my own risk. I recognize that in handling animals there exists a risk of injury, including physical harm caused by animals. I understand it is my responsibility to follow the Flagler Humane Society policies and procedures as described in my volunteer training, and that direct supervision may not be available at all times.
On behalf of myself, my heirs, personal representatives, and executors, I hereby release, discharge, indemnify and hold harmless the Flagler Humane Society, Inc., its agents, agents, servants, employees and board members from any and all claims, cause of action, or demands and any mature of including costs and attorneys’ fees incurred or sustained by me in any way connected with my services performed at Flagler Humane Society, including but not limited to: Animal bites/scratches, accidents, injuries, property damage and/or medical fees.
I agree to all of the above