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Volunteer Adult Application
First Name:
Last Name:
Nickname:
Gender:
Please Select
Male
Female
Spouse's Name:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:
Date of Birth:
Employer:
Work Phone:
Are Your a Seasonal Resident?:
No
Yes
Alternate Address:
Alternate City:
Alternate State:
Alternate Zip Code:
Your safety and the safety of our animals are critically important to us. Toward that end we must ask if you have any physical/health limitations?:
Please Select
Yes
No
If yes, please describe:
Previous experience working with animals and/or volunteering:
Do you speak any languages other than English?:
Please tell us anything else we might like to know about you:
Personal References
Name:
Phone:
Relationship / Years Known:
Emergency Contact Information
Name:
Relationship:
Phone:
I agree to the terms of the COVID-19 policy below:
I attest that to the best of my knowledge, I do not have COVID-19 at the time of volunteering at the Humane Society of the Treasure Coast (“HSTC”), and I understand the risks of unknowing exposure to this and other illnesses by myself, my family, other participants, and third parties. I have not been tested and found positive, am not waiting for test results, and do not have symptoms. I agree that I will not knowingly expose others to any illness I may have or be at risk of. I will follow all HSTC rules and requirements to reduce any exposure and possibility of contracting or spreading the virus. I agree that I am volunteering at HSTC entirely at my own risk and assume all risk and full responsibility for my health, wellbeing, and safety during this activity. I fully agree that HSTC, the officers, board members, and other volunteers are in no way liable for any present or future COVID-19 exposure incurred at any time by any person in attendance or not in attendance, during, or after my volunteering. I hereby waive and release HSTC, the officers, the board members, volunteers, and Landlord from any liability for damages or personal injury to me, my pets, or my property.
By submitting this form you agree with our terms and conditions as found
here.
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