Volunteer Application

HSHA Volunteer Application

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Name: *
Address: *
City/State/Zip: *
Home Phone: *
Cell Phone: *
Email: *
Age Group	18-30 31-40 41-50 51-60 61 or over
Employer: *
Occupation: *
Work Phone: *
May we contact you at work?	Yes No
How did you learn about HSHA's volunteer program?: *
Are you required to volunteer for an employer, school, etc.? If so, please describe.: *
Why would you like to become an HSHA volunteer?: *
Do you have any prior volunteer experience? If so, please describe.: *
Do you have any prior experience in animal sheltering?: *
How do you feel about interacting with various types of people and about taking direction from others?: *
Do you have any companion animals of your own?: *
Are you companion animals spayed/neutered? If no, please explain.: *
HSHA makes every possible effort to work with the needs (behavioral, medical, etc.) of every animal in our care. However, in some instances, euthanasia is necessary. How do you feel about this?: *
Do you have any restrictions, such as work or school, that may affect your ability to volunteer?: *
Do you have any specialized skills or training that could assist HSHA?: *
Do you have any limitations of any kind that may affect your ability to volunteer?: *
Please provide a reference with phone number.: *
Please provide a second reference with phone number.: *
Emergency Contact Name: *
Emergency Contact Relationship: *
Emergency Contact Phone: *
Please indicate the day(s) of the week you would be interested in volunteering.	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Please indicate the time(s) you would be interested in volunteering.	Morning Afternoon Evening
Which volunteer team(s) are you interested in joining?	Dog Walkers Cat Socializers Exotic/Small Animal Socializers Vaccine Clinic Team Laundry & Dishes Office Team Events/PR Team Humane Education Snapshots Volunteers (pet photos) Groundskeeping Shelter Stewards (greeters)
By placing your full name in the box to the right, you are providing your digital signature to indicate your agreement with and understanding of the volunteer agreement below.: *

By signing above, I hereby accept a position as a volunteer for the Humane Society of Harrisburg Area, Inc., upon the following terms, conditions, and understandings.

TERMS AND CONDITIONS
1. My services to the Humane Society are provided strictly in a voluntary capacity as a volunteer and without any express or implied promise of salary, compensation, reimbursement, or other payment of any kind whatsoever.
2. My services are furnished without any employment-type benefits, including, but not limited to, employment insurance programs, worker’s compensation accrual in any form, vacations, or sick time.
3. I will familiarize myself and comply with the Humane Society’s policies and procedures applicable to volunteers. In particular, I fully understand that the Humane Society expects high standards of moral and ethical treatment of the animals under its care. I will adhere strictly to these standards in my capacity as a volunteer.
4. I understand that the Humane Society, without notice or hearing, may terminate my services as a volunteer at any time with or without reason.

RELEASE
1. I understand the risk of harm presented by the handling of animals and other volunteer activities on behalf of the Humane Society. I further understand that volunteer activities may place me in situations that could result in injury to me or my personal property due to the unpredictable nature of animal behavior and interaction of animals that come into the Humane Society’s care, custody, and control. On behalf of myself, and my heirs, personal representatives, and assigns, I hereby release, discharge, indemnify, and hold harmless the Humane Society and its directors, officers, employees, and agents 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 on behalf of the Humane Society.
2. Understanding that public relations is an important part of a volunteer’s activities on behalf of the Humane Society, I hereby authorize the Humane Society to use any photographs of me, acting within my capacity as a volunteer, in its possession for public relations purposes. I ask that the Humane Society use reasonable efforts to give me advance notice of any such use, but such notification is not a condition to release photographs for public relations purposes.

VOLUNTEER ACKNOWLEDGMENT
1. The volunteer handbook, which is available on HSHA’s Volunteer Website, describes important information about the Humane Society of Harrisburg Area, Inc., and I understand that I should consult the Volunteer Coordinator regarding any questions not answered in this handbook.
3. Since the information, policies, and benefits described here are necessarily subject to change, I acknowledge that revisions to the handbook may occur. All such changes will be communicated through official departmental memos, and I understand that revised information may supersede, modify, or eliminate existing policies. Only the Volunteer Department of the Humane Society in conjunction with the Executive Director and the Board of Directors has the ability to adopt any revisions to the policies in this handbook.
4. Furthermore, I acknowledge that this handbook is neither a contract of employment nor a legal document. I understand that it is my responsibility to read and comply with the policies contained in this handbook and any revisions made to it.

EUTHANSIA ACKNOWLEDGMENT
1. The Humane Society is an open admission shelter. By accepting all animals, not just healthy and adoptable animals, as a
volunteer I recognize that euthanasia is part of the environment at our shelter.
2. I understand euthanasia decisions are not made lightly.
3. I understand that I am not allowed to contact any rescues, shelters, or individuals on behalf of HSHA. I can however give information to the Volunteer Coordinator.

MEDIA ACKNOWLEDGEMENT
1. I understand that all media inquiries at both shelters should be directed to the Director of Public Relations or Executive Director.
2. I understand that all correspondence from HSHA to the media should come from the Director of Public Relations or Executive Director. Staff and/or volunteers should never contact any media regarding any HSHA issues.
3. I understand that all campaigns, press releases, appeals, marketing materials, donation jars, Web sites, etc. are created,
distributed and managed by HSHA administration. Staff and/or volunteers should not distribute materials such as these on behalf of HSHA without permission.

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