CHELSEA BAILEY BUTTE SILVER BOW ANIMAL SHELTER
699 Centennial Avenue Butte, Montana 59701
Phone 406-782-8450 Fax 406-723-0264
VOLUNTEER APPLICATION
Date ______Employee ______
Name ______
Address ______
Street City State Zip
Phone ______E-Mail ______
Are you 16 years of age or older? Yes No If no, age ______
Occupation ______
May we contact you at work? Yes No Work # ______
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1. In addition to your love of animals, why are you interested in volunteering for the CBBSB Animal Shelter? ______
2. Some volunteer positions need to be filled on a regular basis.
Please check the days and list the times that you can commit to:
Mon. Time ______to______
Tues. Time ______to______
Weds. Time ______to______
Thurs. Time ______to______
Fri. Time ______to______
Sat. Time ______to ______
Sun. Time ______to______
3. Please explain your experience as a volunteer: ______
______
______
4. Please explain any special skills you may have that would be a benefit for CBBSB to utilize: ______
5. If you are volunteering to fulfill a requirement for a program, please provide the following information:
Name of organization ______
Name of contact person ______
Phone # ______
6. Do you have any allergies? Yes No If yes, what kind? ______
7. Do you have any physical limitations? Yes No If yes, what kind? ______
8. Do you own pets? Yes No
If yes, please list: Type Age Spay/Neutered?
______
______
______
______
9. Will you be able to respect staff decisions regarding the animals at the shelter? Yes No
10. If you are a minor, a parent or guardian must be available to be reached by phone during the time at which the minor is volunteering at the shelter:
Parent or Guardian Name ______
Address ______Relationship ______
Home # ______Work # ______
11. Who should be notified in case of an emergency?
Contact Name ______Phone #______
Address ______Relationship ______
PLEASE NOTE: CBBSB Animal Shelter recommends that volunteers coming in contact with animals be current with their Tetanus vaccination.
VOLUNTEER AGREEMENT and LIABILITY RELEASE
By signing below, I hereby accept a position as a Volunteer for CBBSB Animal Shelter upon the following terms, conditions and understanding.
Terms and Conditions
1. My services to the CBBSB Animal Shelter are provided strictly in a voluntary capacity without any express or implied promise of salary or compensation of any kind. This would include any employment type benefits, including employment insurance programs, worker’s compensation accrual in any form, vacation or sick time or any type of payment.
2. I will familiarize myself and comply with CBBSB Animal Shelter policies and procedures applicable to volunteers. I will abide by the mission, rules, regulations, policies and programs of the CBBSB Animal Shelter while I am a volunteer. In particular, I fully understand that CBBSB expects high standards of moral and ethical treatment of animals under its care.
3. I understand the CBBSB Animal Shelter, without notice or hearing, may terminate my services as a volunteer at any time, with or without reason. If termination occurs I will promptly return all CBBSB Animal Shelter supplies, equipment, records, and all other items in good, clean condition. I also understand that I am not guaranteed a position in the volunteer program.
4. I understand that as a volunteer I may gain access to information about CBBSB Animal Shelter, staff, customers, and other volunteers that is confidential. I agree to maintain confidentiality and refuse to disclose any information that is either private or personal.
Liability Release
1. I understand that the handling of animals and other volunteer activities on my behalf of CBBSB Animal Shelter may place me in a situation that could result in injury to me or my personal property. I assume the risks of being bitten, scratched, injured or frightened by dogs, puppies, cats, kittens or other shelter surrendered animals in connection with my volunteer work.
2. I authorize CBBSB Animal Shelter to seek emergency medical treatment for me in case of accident, injury or illness and to indemnify and hold harmless CBBSB Animal Shelter in such an event. I understand that CBBSB Animal Shelter Workers Compensation policy volunteers are not classified “employees” and are therefore not eligible for coverage for injuries sustained while volunteering for CBBSB Animal Shelter.
3. On behalf of myself, and my heirs, personal representatives and assigns, I hereby release the Chelsea Bailey Butte Silver Bow Animal Shelter of all liability for injuries, damages, liabilities, losses, judgments, costs or expenses whatsoever, which I might suffer or sustain in connection with the performance of my volunteer activities for CBBSB Animal Shelter.
4. I discharge, indemnify and hold harmless CBBSB Animal Shelter, its directors, officers, employees, members and agents from any and all claims, lawsuits, injuries, damages, losses, costs or expenses whatsoever sustained by any shelter animal or any person in connection with my intentional misconduct or grossly negligent performance of volunteer activities for CBBSB Animal Shelter, or breach of CBBSB Animal Shelter’s rules, regulations, policies and programs.
5. Understanding that public relations are an important part of volunteer’s activities on behalf of CBBSB Animal Shelter, I hereby authorize CBBSB Animal Shelter to use any photographs of me in its possession for public relations purposes.
6. I have accurately and truthfully completed the Volunteer Application.
7. Any modification to this Agreement must be in writing signed by both parties. This agreement is binding upon CBBSB Animal Shelter, me and my respective heirs, successors, assigns, executors and personal representatives.
Signature ______Date ______
CBBSB Animal Shelter Representative ______