1. Volunteers Under the Age of 17 Must Have Written Permission from a Parent/Guardian

Please Note:

1.  Volunteers under the age of 17 must have written permission from a parent/guardian.

2.  The shelter does not accept temporary volunteers seeking to satisfy a court-ordered community service requirement.

3.  Completion of this application does not guarantee acceptance into the program.

4.  Incomplete applications will not be processed.

5.  Please print legibly or your application will not be considered.

Full Name: ______

Last First Middle

Date of Birth: _____/_____/______Home Phone: ______

MM DD YYYY

Cell Phone: ______Email: ______

Home Address: ______

Street City State Zip

How many hours do you feel you can commit each month? ______

What are your preferred dates and times of availability?

Mon______Tues______Wed______Thurs______Fri______Sat______Sun______

Are you a member of any animal welfare organizations? Yes No

If yes, how do you participate? ______

While we try our best to help each animal in our care find a home, there are instances when an animal, due to space, medical, behavior or other reasons must be euthanized or put to death. Although you will not be involved in the process, we would like to know how you feel about it.

______

______

Some volunteer tasks may include lifting, bending, or carrying cages or other heavy supplies as well as handling, grooming or moving large animals. Some volunteer positions require the ability to safely return animals to their appropriate cages/kennels and to read kennel cards. Volunteers must be alert at all times being around unpredictable and dangerous animals and able to communicate with employees and the public. Do you have any allergies, health/physical condition(s), disabilities or psychological limitations which may restrict/hinder your activities as listed above or put you in any sort of danger? Yes No

If yes, list special accommodations needed: ______

______

What is your motivation to volunteer with us (check all that apply)?

help animals dog walker cat socialization

photography internet advertising press releases

creating animal info sheets facebook coordinator volunteer coordinator

adoption counselor dog washing grooming animals

fundraising grant writer bylaws

foster parent (dog) (cat) work adoption events (set up) (tear down)

other: ______

1.  The City of Liberty established the policies and procedures of the Animal Shelter.

2.  The Texas Department of Health establishes the regulations that the Animal Shelter Officers of the Liberty Police Department must follow.

3.  Volunteers serve at the discretion of Police Department management and can be removed as necessary should a volunteer be in violation of any rules, policies or orders. While the Police Department recognizes the need to have volunteers work with the Animal Shelter, Police Department management is under no obligation to work with volunteers and can discontinue their work with a volunteer at any time.

4.  Volunteers are not paid.

5.  Volunteers shall understand the Animal Shelter is not a “no kill” facility. Due to constraints and limitations on space, budgets, and for liability reasons, animals are euthanized. No volunteer will participate or be present at euthanization.

6.  Only Animal Control Officers may handle animals designated as “dangerous” or animals in isolation or quarantine for a bite or court hold. Volunteers are expected to adhere to all postings and warnings with regard to the handling of animals.

7.  Volunteers may not remove animals from the Police Department property without the written permission of an Animal Control Officer.

8.  Friends, relatives and children of volunteers are not allowed in the Shelter while the volunteer is performing his/her duties unless they have been approved as a volunteer.

9.  Violation of any criminal law while performing the duties of a volunteer will subject the volunteer to termination and possible criminal charges.

10.  Volunteers must pass a background check prior to beginning any duties.

11.  Volunteers living inside the city limits of Liberty are required to obey all city ordinances and state laws pertaining to the keeping and caring of animals.

12.  Volunteers are under the direct supervision of the Animal Control Officers. Failure to follow their directions will result in the volunteer’s dismissal.

I do hereby authorize a criminal history record check concerning myself, by and to duly authorized agents of the Liberty Police Department. I emphasize that the intent of this authorization is to provide information for the specific purpose of pursuing a background investigation which may provide pertinent data for the Liberty Police Department to consider in determining my suitability for volunteer services for the City of Liberty Animal Shelter Pals of the Pound. A photocopy of this release form will be valid as an original hereof, even though said photocopy does not contain an original writing of my signature.

Maiden Name: ______

Signature: ______Date: ______

For Official Use Only / Background Completed By: / Date Completed:
Chief Approval: Yes No / Chief Signature: / Date Approved:

LPD Form #: 112 Rev: 6.2012