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Date of Application
1. Name :
Address:
City State: Zip
Telephone
Home: cell: work:
2. Number of people in home:__________adults: _____ ages: ____________ children: _____ ages:
3. When will you be ready to volunteer?
4. Why did you choose to volunteer with this particular breed of dog?
5.Do you have animals now? What kind? (list breed/age/sex)?
Are they neutered or spayed? If no, please explain:
6. List any animals you have had in the past, include name, breed & sex:
7. Please list 3 references (2 non-family members):
a) Name: Relationship: e-mail:
b) Name: Relationship: e-mail:
c) Name: Relationship: e-mail:
8. In Volunteering for our dogs, and SHRR, you agree to:
a) Accept responsibility at your own risk, and hereby release and waive any right against SHRR which you may have now, or in the future, for any damages to person or property causeed by said animals. During events and get-togethers you need to know and recognize that animals, like humans, differ in their responses to different situations and that we cannot make any claims or representations as to the previous or future behavior and actions of the animals.
b) Represent SHRR in an appropriate and courteous fashion. You will not discuss any confidential information you are given.
IN SIGNING BELOW YOU AGREE TO ALL OF THE TERMS ABOVE AND UNDERSTAND THAT IF YOU HAVE GIVEN FALSE OR MISLEADING INFORMATION OR DO NOT FOLLOW THE TERMS OF THIS CONTRACT, ANY OF THE ABOVE AS INDIVIDUALS OR AS AN ORGANIZATION MAY TERMINATE VOLUNTEER STATUS AND START LEGAL PROCEEDINGS AGAINST YOU, AT YOUR EXPENSE, AND MAY ASSESS DAMAGES IN THE AMOUNT OF $1000.00 AGAINST YOU. FAILURE TO COMPLY WITH ANY OF THE ABOVE TERMS OF THIS AGREEMENT MEANS THAT THE VOLUNTEER WILL IMMEDIATELY BE DISCHARGED FROM SUPERIORS HAVEN ROTTWEILER RESCUE, AND WILL NO LONGER REPRESENT SHRR IN ANY WAY.
I HAVE READ, UNDERSTAND, AND WILL COMPLY WITH ABOVE STATED CONDITIONS.
Signature: Print Name: Date:
