Woodrock Animal Rescue NPO Home Checker Application Form V1.0
Please send completed form to /

Home Checker Volunteer Contact Information

Name and Surname
ID Number
Gender
Age
Physical Address
Contact Number
Alternate Contact Number
E-Mail Address
NOTE: Home Checkers must be 18 years or older.

Home Check Areas

Please mark the area/s that you are able to assist with.

Area / Yes/No / Area / Yes/No / Area / Yes/No
North Johannesburg / Central Johannesburg / Pretoria West
East Johannesburg / Pretoria North / Centurion
West Johannesburg / Pretoria South / OTHER
South Johannesburg / Pretoria East

Please list the suburbs in the above areas marked Yes, that you would prefer to assist with.

In your opinion what is the perfect home?

Why do you want to be a Home Checker for Woodrock Animal Rescue? (Please explain)

What experience do you have with dogs? (Please explain)

Have you ever conducted home checks before? (Please explain)

Any Other Comments

Other ways you could help Woodrock with volunteering

Woodrock often needs volunteers to assist with other tasks. What other skills and qualifications do you have that you would like to use to help Woodrock, and how do you see them being used? Do you have any ideas for this?

Liability Disclaimer for Volunteer Work at Woodrock Animal Rescue

Woodrock Animal Rescue does not provide liability insurance for the protection of individuals, groups, organisations, businesses, spectators, or others who may participate in the volunteer work for Woodrock Animal Rescue.

In consideration for your participation in said volunteer work for Woodrock Animal Rescue, the individual, group, organisation, business, spectator, or other, does hereby release and forever discharge Woodrock Animal Rescue and its officers, board, and employees, jointly and severally from any and all actions, causes of actions, claims and demands for, upon or by reason of any damage, loss or injury, which hereafter may be sustained by participating in the volunteer work for Woodrock Animal Rescue.

This release extends and applies to, and also covers and includes, all unknown, unforeseen, unanticipated and unsuspected injuries, damages, loss and liability and the consequences thereof, as well as those now disclosed and known to exist. The provisions of any local or territorial law providing substance that releases shall not extend to claims, demands, injuries, or damages which are known or unsuspected to exist at this time, to the person executing such release, are hereby expressly waived.

I hereby agree on behalf of my heirs, executors, administrators, and assigns, to indemnify Woodrock Animal Rescue and its officers, board and employees, joint and severally from any and all actions, causes of actions, claims and demands for, upon or by reason of any damage, loss or injury, which hereafter may be sustained by participating in the volunteer work for Woodrock Animal Rescue.

It is further understood and agreed that said participation in the volunteer work for Woodrock Animal Rescue is not to be construed as an admission of any liability and acceptance of assumption of responsibility by Woodrock Animal Rescue its officers, board, and employees, jointly and severally, for all damages and expenses for which Woodrock Animal Rescue its officers, board and employees, become liable as a result of any alleged act of the volunteer participant.

Person to Notify in Case of Emergency

Name
Street Address
Contact Number
E-Mail Address

Agreement and Signature

I understand that if I am accepted as a volunteer Home Checker, any misrepresentation made by me on this volunteer application may result in my dismissal. I accept the Liability Disclaimer above.

Name
Signature
NOTE: If completing electronically, please put name in signature and bring signed form to when visiting Woodrock.
Date

Please send completed form to

Thank you for completing this application form and for your interest in helping us with home checks. To be a home-checker you need to have an open mind. We all have varying standards as to what constitutes “the perfect home”. Not every home suits every dog and not every dog suits every home. Woodrock appreciate and value your service and will endeavor to keep you, the home-checker in the loop as to progress of the adoptions for the home checks which you conducted.

We are the voice for the voiceless.

Woodrock Animal Rescue

Woodrock Animal Rescue NPO Home Checker Application Form V1.0 2016