Volunteer Application - Lucy Mackenzie Humane Society

Name*

Date of birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Daytime Phone Number*

Evening Phone Number

Would you prefer to be contacted via?*

Who should we contact in case of emergency?*

Emergency Contact Phone Number*

What is your relationship to this person?*

Are you currently employed?*

Employer

What is your occupation?

Does your employer have a Volunteer Matching Program?

What volunteer opportunities are you interested in?

What days and hours are you available to volunteer? We welcome our volunteers everyday of the week between 9 AM-11:30 AM and 12 PM - 4 PM with some exceptions.

Please tell us why you'd like to volunteer at Lucy Mackenzie.

Volunteer Agreement - Please read and type your name below.

I hereby asser that I freely and voluntarily agree to provide volunteer services to Lucy Mackenzie Humane Society (LMHS) from time to time and at my discretion as set forth below. I understand that LMHS is a non-profit public charity and I choose to volunteer my services based on my own desire to contribute to my community for civic, charitable and/or humanitarian purposes. I understand that I am in no way obligated to do so and that my hours of service as a volunteer at Lucy Mac are served with no promise, expectation, contemplation or receipt of compensation or benefits for the services rendered. During my time as a volunteer, I agree to act in the best interest of LMHS and the animals and to abide by any policies, procedures, rules and regulations as they are set forth. I shall keep confidential all matters that are not otherwise known to the public concerning LMHS and its animals, customers, adoption applicants, donors, or any other matter relation to LMHS affairs. LMHS has my permission to use any and all photos or videos taken of me for promotional use or to advertise an event. I understand that all prints, film and negatives become the property of LMHS and may be used without prior notification or compensation. I authorize LMHS to seek emergency medical treatment in case of injury, accident or illness. While LMHS is very concerned about the safety and well-bring of its volunteers, I acknowledge that it is my sole responsibly to exercise caution and good judgement. I understand and voluntarily assume the risks associated with volunteering for LMHS.

Consent and Release from Liability

I, as a volunteer service provider to Lucy Mackenzie Humane Society (LMHS), hereby knowingly, freely and voluntarily waive my right or cause of action whatsoever arising as a result of such activity from which any liability may or could occur against LMHS or its agents or employees, jointly or individually. I declare that I shall not hold LMHS liable for any illness, injury or disease that I might contract or sustain while I am working in said capacity. I also understand that I am not covered under worker's compensation. I fully recognize the possible dangers associated with the work of LMHS and I freely consent to this waiver. LMHS makes no representations concerning any animals' exposure to rabies or other diseases.