Gloucester-Mathews Humane Society Volunteer Program Application
Want to join our Volunteer Team? Please fill out this form and we will be in touch soon.
E-pasta adrese *
Volunteer Requirements:
1. All volunteers must be at least 16 years old.
2. All volunteers must fill out the volunteer application.
3. All volunteers must complete their scheduled training.
4. All volunteers must purchase a volunteer shirt ($10) and wear it every time you come to GMHS.
5. All volunteers must wear closed-toe shoes. No sandals or flip flops.
6. All volunteers must wear long pants. No shorts, skirts, dresses, etc.
Is this for Community Service hours? *
First and Last Name *
Phone Number *
Birthday *
MM
/
DD
/
GGGG
Mailing Address *
Emergency Contact *
Parent/Guardian Name (Required if under 18)
Have you ever been charged with and/or convicted of a felony? *
Do you have any physical restrictions, medication limitations, or allergies?  *
Would you submit to a Fingerprint Background Check? *
Summarize your experience with animals. *
List special skills you may have that would be helpful (i.e. graphic design, carpentry, website administration, etc.) *
Provide two references. *
Please check all volunteer opportunities you are interested in: *
Jāaizpilda obligāti
GMHS Volunteer Agreement:
I make the following statements and voluntarily enter into this Volunteer Agreement (hereinafter “Agreement”) to provide exercise and socialization to the animals with which I am authorized to interact, and to volunteer in other capacities at the Gloucester-Mathews Humane Society (hereinafter, GMHS).

-I have never been convicted of animal cruelty, neglect, or abandonment.
-I agree to comply with all other federal, state and local laws that pertain to companion animals and pet ownership in the jurisdiction where I reside.
-I agree that my services to GMHS are provided strictly in a voluntary capacity as a volunteer, and without any express or implied promise of salary, compensation, benefits, or other payment of any kind whatsoever. I further agree that nothing in this Agreement shall be construed as creating an employment relationship between Gloucester, Mathews or Middlesex counties and me.
-I fully understand the GMHS expects high standards of moral and ethical treatment of the animals under its care. I agree to strictly adhere to these standards in my voluntary capacity at the GMHS.
-I have made known any physical or mental condition that would impair my ability to perform my duties as a GMHS volunteer.
-I agree to comply with all requests, directives, orders, guidance and other written and oral instructions given to me by GMHS staff. Concerns with shelter staff should be reported to the Volunteer Coordinator.
-I agree to seek immediate medical attention if I am scratched or bitten by any shelter animal, or if I receive any other physical injury resulting from my volunteering at GMHS.
-I agree to notify GMHS staff if I am bitten by an animal.
-I agree to not criticize or disparage the GMHS, either verbally or in any public or social media. I will not represent my views as those of GMHS, nor speak on behalf of GMHS to media (all forms).
-I will refrain from giving any medical or “expert” advice to visitors at the shelter, and shall not recommend a particular veterinarian over others to a visitor at the shelter.
-I will not remove any shelter property, including food, leashes, and other supplies from the shelter premises without written permission from the Shelter Manager or Volunteer Coordinator.
-I understand and agree that GMHS may terminate this Agreement and my participation in the volunteer program at any time for any reason and without prior notice.
-I agree to return all equipment and other supplies issued to me by GMHS upon termination of this Agreement and my participation in the Volunteer program.
-I understand that I may come into contact with or have access to a wide variety of confidential information. Such confidential information includes, but is not limited to, contact information for other volunteers and staff, administrative proceedings, and any information designated as confidential orally or in writing by GMHS staff. I agree not to disclose such confidential information to anyone without the prior written authorization from GMHS staff. I understand that disclosure of any such confidential information, verbally or in writing, may be grounds for immediate termination of this Agreement and my participation in the GMHS Volunteer Program.
-I understand that while GMHS staff carefully monitors all animals, GMHS may have limited knowledge of their behavioral and medical backgrounds. I understand that GMHS makes no warranties or representations regarding any animal’s health or behavior.
-I agree to assume all risks implicit in working with animals at GMHS, including those who may have been abandoned, beaten, mistreated, abused, or who may suffer from an illness or disease. I understand that these risks include physical harm caused by animals I may come into contact with, and exposure to diseases that may be transmittable to me, other humans, and other companion animals.
-I understand and agree that GMHS, its members, officers, directors, agents and elected board members have no liability or responsibility of any nature for injuries or damage to any person, animal, or property which may be caused by animals at GMHS or my participation in the GMHS Volunteer Program. I, for myself and my heirs, executors, administrators and assigns, hereby release, indemnify and hold harmless GMHS, its members, officers, directors, agents, and board members, and their heirs, administrators, executors, successors, and representatives from all liability for and all risk of damage or bodily injury or death that may occur to me, including any injury based on negligence, now or hereafter in connection with my participation as an GMHS volunteer. I expressly agree that this release, waiver and indemnity is intended to be as broad and inclusive as permitted by the Commonwealth of Virginia and that if any portion is held invalid, the remainder shall continue in full force and effect.

By my signature below, I agree to abide by the terms of this Agreement.
Signature *
PARENT OR LEGAL GUARDIAN (OF VOLUNTEERS UNDER 18 YEARS OF AGE)

As a parent or legal guardian of the above named volunteer, I hereby give my consent to allow my child/ward to perform volunteer services for the Gloucester-Mathews Humane Society as described within the Volunteer Application.  

Signature of Parent or Legal Guardian: 
Jūsu atbilžu kopija tiks nosūtīta uz jūsu norādīto e-pasta adresi.
Iesniegt
Notīrīt veidlapu
Nekad neiesniedziet paroles, izmantojot Google veidlapas.
Šī veidlapa tika izveidota domēnā Gloucester-Mathews Humane Society. Ziņošana par ļaunprātīgu izmantošanu