Community Service Application

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Thank you for your interest in completing your community service hours with Humane Pennsylvania! If you are required to complete community service hours by the Court, or by your school, please complete the following application.

At which shelter would you like to complete your community service hours? Please check all that apply. *

Freedom Center for Animal Life-Saving: 1801 N 11th Street, Reading, PA 19604

Humane League of Lancaster County: 2195 Lincoln Hwy E, Lancaster, PA 17602

Required

Today's Date *

YYYY

First Name *

Last Name *

Date of Birth *

YYYY

Street Address

City *

State *

Zip/Post Code *

Phone Number *

Email Address *

Completion Due Date *

YYYY

Number of hours required by (school or court) *

Name of school or court contact *

Email address for school or court contact *

Is your community service court ordered?

Yes

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If court ordered, what is your offense?

Application Waiver

I, the undersigned, hereby fully and forever waive, release, hold harmless, indemnify and defend Humane Pennsylvania and its respective employees, volunteers, agents, officers, board members, trustees, successors and assigns, together with their insurance carriers (collectively “Humane Pennsylvania”), from and against any and all actions, claims, demands, causes of actions, lawsuits, controversies, expenses or damages of every nature whatsoever, which I may have now or in the future against Humane Pennsylvania, for any and all personal injuries of any kind and nature, mental or emotional injury, including but not limited to any claim of intentional or negligent infliction of emotional distress, as well as any and all other types of losses, including property damage, all economic and non-economic claims, injuries to other pets and other damages, known and unknown, arising out of or attributable to my participation in the handling of animals at Humane Pennsylvania.

By typing your first and last name below you confirm that you read the application waiver above and that all the information provided on this form is truthful and accurate. *

Once your application has been reviewed by Humane Pennsylvania staff, you will receive an email letting you know if we can accommodate your community service needs. This email will include further instructions, including scheduling options.

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