Heartland Humane Society Volunteer Application & Liability Release
Interested in volunteering, please fill out the form and a staff member will reach out to you in a timely manner.
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Email *
Today's Date *
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Name: *
Address: (Street, City, State, Zip) *
Phone: *
Date of Birth: *
Age: *
Emergency Contact & Phone Number: *
Are you presently in school? If yes, name of school: *
Are you presently employed? If yes, where: *
Describe present and previous volunteer jobs or experience working with animals: *
Animals currently residing at residence: *
Why are you interested in becoming a HHS volunteer?: *
Have you ever been convicted of a felony? If yes, when and please explain: *
How did you hear about the HHS volunteer program? *
Required
Are you available regularly each week?: *
Required
Volunteer placement option and times.
There are many different ways you can help out! Think about and choose which placements you feel comfortable with. We will place you in the areas that have the most need but can train you in other areas if you would be willing to sub or take on another duty.
Ways that I want to help. *
Required
Slots I can fill in:
Choose days that would be consistently available to you. We will place you within these days and then work with you on times that are needed.
Please choose day(s) you are available. *
Required
Please choose time frames you are available. *
Required
Volunteer Release of Liability & Hold Harmless Statement
All persons volunteering at the shelter or participating in any event or activity organized or sponsored, in whole or in part, by Heartland Humane Society are required to read, agree to, and sign this waiver before participating in any such event or activity. Please acknowledge that you have read each section by INITIALING where indicated.
(If you are under 18 years of age, a parent or guardian must also provide initials & a digital signature.)
Waiver of Liability for Services Performed On Site:
I hereby release and forever discharge Heartland Humane Society, and its employees, volunteers, directors, officers, administrators, agents, and assigns (hereinafter collectively and severally referred to as “HHS”) from all liability for any and all claims, demands, actions, causes of action or suits of any kind whatsoever, and particularly on account of any injuries, to person or property sustained while performing services, voluntary or otherwise, at the Heartland Humane Society facility located at 3400 East Highway 50 in Yankton, South Dakota. 
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Waiver of Liability for Services Performed Off Site:
I hereby release and forever discharge HHS from all liability for any and all claims, demands, actions, causes of action or suits of any kind whatsoever, and particularly on account of any injuries, to person or property sustained while performing services, voluntary or otherwise, on behalf of, or in conjunction with, HHS which occurs as a result of participation in any event or activity sponsored or endorsed by HHS, including, but not limited to, any event or activity promoted in connection with HHS or its membership program and travels to/from any such event.
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Responsibility to Report Injuries:
I agree to immediately report all injuries or disease I may receive while on the property of the Heartland Humane Society or while working in the service of HHS, including but not limited to animal bites, deep scratches, and slips or falls. I agree to file an Incident Report immediately following any such injury. If I am unable to file a written report, I agree to contact the Executive Director or Director of Operations within 24 hours of the incident and inform them of said incident.
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Agreement to Indemnify:
I further agree that if, despite this Release of Liability and Hold Harmless Agreement, I or anyone on my behalf makes a claim against HHS, I will indemnify, save and hold harmless HHS from any damages, losses and expenses including, but not limited to, legal fees, courts costs, and litigation expenses. I agree to indemnify and hold harmless HHS from any and all liability, damage, loss, cost and expense incurred as a result of any claim, demand or cause of action brought against HHS, jointly or individually, for bodily injury, death or property damage suffered as a result of my own negligent, reckless or willful act, omission in the performance or failure to perform his/her volunteer services.
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Acknowledgements
Neither this waiver nor the circumstances leading to its execution shall be deemed an acknowledgement by HHS that, as of the date hereof, any such claim exists or will exist or that the activities and events of HHS are hazardous or present any unusual risks.

I acknowledge and agree that I: (a) fully understand the meaning of this Release and Waiver and recognize my right to seek the advice of an attorney before signing it; (b) have signed it freely and without any inducement or assurance of any nature; (c) intend it to be a complete unconditional release of liability to the greatest extent allowed by law; and (d) agree that if any portion of this agreement is held to be invalid the balance not withstanding shall continue in full force and effect.

The acceptance of this release shall not operate as an admission of liability on the part of anyone, nor as a waiver or bar with respect to any claim that HHS may have against the undersigned. This release is binding on my heirs, executors, assigns and administrators. The undersigned is aware of the risks of attending, traveling to and participating in said events or activities and hereby assumes all risks. The risks include those foreseen and unforeseen, known and unknown.
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I hereby declare that I am over the age of eighteen (18) years old and that I have read and understood and voluntarily accepted the terms and conditions of this Release of Liability and Hold Harmless Agreement.
E-Signature & Date: *
Parent/legal Guardian E-Signature & Date (If under 18 years of age):
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