Specialized Adult Volunteer Application

This is not the standard Adult Volunteer Application. This is used for specialized purposes only. Please fill this out only if sent directly to you by the Volunteer Director.

Next steps:

1. Email a headshot of the adult volunteer only (please include name) to [email protected].

2. The program coordinator will contact you for next steps once all information is entered which is approximately one week to ten days.

Step 1 of 4

Name*
First Middle Last
Please use your full legal name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone
Cell Phone*
Email*
Employer
Occupation
Birthdate*
Month
Day
Year
Driver's License #*
Shirt Size*
Emergency Contact*
First Last
Relationship*
Home Phone
Cell Phone*

Have you ever been a volunteer at the Humane Society of Broward County?*
- Yes
- No
When were you a volunteer?*
Please list any previous pet volunteer experience at other organizations.*
Many large corporations help to support the community by offering their employees a “matching fund or matching donation”. This means that they will make a financial donation towards their employees’ volunteer service hours. Also, some corporations provide grants for special projects at local non-profit agencies.
In signing, I understand and agree to the following: - I understand that if I am absent for 1 month or, if I am not fulfilling the required scheduled shifts I agreed to, my status as an active volunteer may change to inactive without notification from the Humane Society. - I agree to be supervised by a designated staff person or another volunteer designated by my supervisor. - I agree to take direction from my direct supervisor or a volunteer who has been assigned to supervise me. - If I feel that if a communication problem exists between the staff and me, I will report the problem to my direct supervisor. - I will come appropriately dressed, wearing closed-toed shoes, jeans (no tears) or sturdy pants, and a volunteer uniform shirt. - I will be on time and will contact my supervisor or the Director of Volunteer Services if I am going to be late or absent. - I will treat all the animals, people and property with respect and express myself using appropriate language. - I understand that I cannot bring friends or family members with me when reporting to my shelter position. - I understand that as a volunteer, I may gain access to information about sheltered pets, customers, staff, and other volunteers and I agree to maintain confidentiality and to not disclose any information that is private or personal. - I understand that due to the sensitive nature of euthanasia, I will not intentionally look into the records of any shelter animal specifically for the purpose of discovering its outcome. Likewise, I will not ask any staff member for the specific outcome of a sheltered animal.
a. 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. b. I understand that the Humane Society, without notice or hearing, may terminate my services as a volunteer at any time, with or without reason and am not eligible for compensation or benefits for services rendered. c. I certify and warrant that I am in good physical condition and able to participate as a volunteer in the capacity I agree to and I do agree to participate at my own risk.
1. I agree to release, discharge, indemnify and hold the Humane Society harmless for any and all damage to my personal property while performing my volunteer services to the Humane Society in a volunteer capacity. 2. I recognize that in handling animals at the Humane Society, while performing my volunteer services, there exists a risk of injury including personal physical harm. On behalf of myself, my heirs, personal representatives and executors, I hereby release, discharge, indemnify and hold harmless the Humane Society, its agents, servants, and employees from any and all claims, causes of action or demands, of any nature or cause connected with my Volunteer Agreement. This might include costs, attorney's fees and court costs incurred by the Humane Society in connection with my volunteer services based on damages or injuries which may be incurred or sustained but are not limited to animal bites, accidents, injuries, and personal property damage. 3. I understand that public relations are an important part of volunteering at the Humane Society. I, therefore, agree on behalf of myself, my heirs, personal representatives, and executors to allow the Humane Society to use any photographs taken of me for use in public relations efforts. The Humane Society will use reasonable efforts to notify me but such notification is not a condition of the photographs' release for public relations purposes. 4. Volunteer hereby expressly and specifically assumes the risk of injury or harm and releases the Humane Society from all liability for injury, illness, death or property damage resulting from the activities and/or volunteer’s negligence. Volunteer also agrees to indemnify the Humane Society for any injury they cause another, and that all related medical costs incurred are the responsibility of the volunteer. 5. I understand that any work performed in any capacity is voluntary in nature and no employment relationship or compensation is implied, additionally except as otherwise agreed to by the Humane Society in writing, the Humane Society does not carry or maintain health, medical, workers compensation, liability or disability insurance coverage for any volunteer.
Volunteer Agreement Signature*
I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE TERMS AND CONDITIONS OF THE VOLUNTEER AGREEMENT. I AGREE TO CONDUCT MYSELF IN THE MANNER OUTLINED AND I ACKNOWLEDGE THAT FAILURE TO COMPLY MAY LEAD TO MY REMOVAL FROM THE VOLUNTEER PROGRAM WITH THE HUMANE SOCIETY OF BROWARD COUNTY.

You will be required to complete an authorization form allowing the HSBC to perform a multi-state criminal background check. We will ask for a $40 fee to cover the cost of the background check as well as your volunteer shirt, badge, and lanyard.
In connection with my application to volunteer with the Humane Society of Broward County, I understand that it is the policy of the HSBC that all newly recruited volunteers will have investigative background inquiries that may include criminal convictions, motor vehicle, social security number and other reports. I understand that the HSBC will be requesting information from various Federal, State, County and other agencies which maintain public records relating, but not limited to, driving, criminal history, civil and other experiences. I authorize without reservation, any party or agency contacted by the Humane Society of Broward County to furnish the above mentioned information. I hereby consent to your obtaining the above information from various Federal, State, County and other agencies which maintain public records including but not limited to LexisNexis Screening Solutions and/or any of their licensed agents. I understand to aid in the proper identification of my file or record the following information, as well as other information, is necessary.*
- Agree
I acknowledge the ways in which the COVID-19 virus can be contracted including direct or indirect contact with an infected person, inhaling or having infected droplets enter the body through other orifices, direct human contact with an infected person, and possible surface transmission. Until I’m told otherwise, I agree to maintain social distancing of a minimum of six (6) feet from other people, wash and/or sanitize hands regularly following the CDC’s washing protocol posted by all sinks in the facility, which include continuous washing of hands with soap for a minimum of twenty (20) seconds. Hand sanitizer can be used but this does not replace washing with soap and water regularly. You must wear a mask at all times when other people are present. Masks must fully cover your nose and mouth and must be able to be pulled past the chin. You are not permitted to enter the building if you experience any signs of illness including but not limited to fever, headache, loss of smell, or flu-like symptoms. We also ask that you do not enter the building for fourteen (14) days if you’ve been exposed to a person that tested positive for the COVID-19 virus, or if you’ve traveled to a region of the United States or internationally that has been highly impacted with confirmed cases of COVID-19. I acknowledge the risk involved with potential exposure to the COVID-19 virus including illness or death, and agree to assume all medical and legal expenses and all other liabilities and related expenses or outcomes.*
- Agree
I certify that all the information which I have given the HSBC is true and accurate.*
- Agree
Digital Signature*
Type your full, legal name here
Other names used*
Maiden names, nicknames, etc.

Specialized Adult Volunteer Application

Step 1 of 4

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