First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

Must be 18 yrs or older, if younger have your parent/guardian fill out the application.*

Do you have children who would like to volunteer? If so what are their names and ages? *Children under 16 MUST have a parent/guardian volunteer with them*

Please check the areas that you would be interested in assisting with as a SCHS volunteer.

What days and hours of the week are you available for volunteer work? *

Briefly share why you would like to volunteer with our organization. *

Have you previously volunteered or worked with an animal welfare nonprofit? *
Choose one: Yes No

If you have volunteered or worked with another animal welfare nonprofit, please explain.

For all pets living in your household please list the name, species, age, if spayed, neutered or intact, where kept (indoor/outdoor/both), and most recent vaccination date.

Have you adopted a pet from SCHS before?

If you adopted a pet from us before, what is the pet's name? If you no longer have the pet, please explain why.

Have you ever been convicted of a felony or charged with abuse of an animal?

If you have been convicted of a felony or charged with animal abuse, please explain.

By submitting this online form I am confirming that I have read the SCHS Volunteer Policy and Procedures Manuel (which can be found on the Volunteer Info page of our website under the HOME tab) and I agree to follow these policies and procedures. If I am volunteering to foster, I will read and follow the cat or dog program SOP as appropriate. I fully understand that the Scott County Humane Society (SCHS) and the Scott County Animal Shelter (SCAS) handle large numbers of animals on a daily basis. The temperament and medical history of these animals is often unknown. I acknowledge that all animals are unpredictable in their behavior and can bite, scratch or otherwise injure persons and destroy or damage property. SCHS makes no warranty as to the behavior of any animal in our care and I accept the risk of working around animals. I understand that the handling and fostering of animals and other Volunteer activities on behalf of the SCHS may place me and my children in a hazardous situation and could result in injury to me, my children or other family members, pets, personal property, and/or those around me. I understand that because I or my children will be in contact with animals, it is important to make sure our vaccinations such as tetanus are current and I will consult with our physician as to what vaccinations are needed. If fostering animals, I agree to keep all my personal animals up to date on vaccinations and health care including rabies as required by law. I agree that I am fostering at my own risk. On behalf of my heirs, personal representatives and assigns, I hereby release, discharge, indemnify and hold harmless the SCHS/SCAS and its directors, officers, employees, agents, and volunteers from any and all claims, causes of action and demands of any nature, whether known or unknown, arising out of or in connection with my Volunteer activities or those of my children on behalf of the SCHS.*
Choose one: Yes No