STAFFY RESCUE VOLUNTEER APPLICATION

Staffy Rescue Volunteer Application
Today's Date*

MonthDayYear
Full Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState

Country
E-mail*
Home Phone*

Area CodePhone Number
Mobile Phone*

Area CodePhone Number
Date of Birth

DayMonthYear
I am*

working Full Timeworking Part timea stay home parenthave retiredstudy full timestudy part timeOther
Have you worked/volunteered with a rescue shelter or animal care?*

YesNo
If yes, please list organisation(s)
Are you still currently involved with these organisation(s)

YesNo
I also understand that behavior of domestic animals are at times unpredictable and that some domestic animals are capable of inflicting property damage, serious personal injury and even death. I am well aware of the risk of handling domestic animals, and with such understanding, I hereby waive, release and forever discharge Staffy Rescue and its employees/volunteers, agents or trainers from any and all claims (whether present or future) arising out of the participation as a volunteer.
what day of the week would you be available*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
please list any previous experence with handling animals*
any further queries or information
Volunteer Liability Release Form
Volunteers are an important part of Staffy Rescue and we welcome those who wish to participate in our

programs. To become a volunteer at Staffy Rescue

1. You must have an application on file and have attended our orientation briefing

2. You must willingly sign this form outlying the risks of volunteering.

3. Be prepared to travel to north western Sydney to volunteer at Staffy Rescue facilities.
Today's Date*

DayMonthYear
I verify that all above details are true and correct
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
I certify that as of today's date, I am over 18 years of age.*

Clear
If between 16-18 years old: I certify that my guardian* will be with me at all times while I am volunteering for Staffy Rescue

Clear
Guardian's Name

First NameLast Name
Guardian's Address

Street Address

Street Address Line 2

CityState

PostcodeCountry
Guardian's Phone

Area CodePhone Number
Guardian's Address
Tetanus Advisory: You are strongly urged to have a current tetanus vaccination to protect yourself should you be cut, scratched or otherwise injured in such a way that tetanus infection could threaten your health.
Acknowledgement of Tetanus Advisory*

Clear
Date of last tetnis shot*

DayMonthYear
Release of Liability: I fully understand that as a part of my volunteer work at Staffy Rescue I will become in contact with animals either by direct handling or assisting in their care. Further, I understand that working with animals carries a risk of injury, and that it is possible that I may be bitten, scratched, and/or otherwise injured. I also understand that I may be exposed to canine illness and disease and that it is also possible that I could indirectly expose my own pets to such illness and disease. My signature to this volunteer liability release attests to my intent to hold harmless and release from all liability Staffy Rescue and their agents and assigns from all acts which are related to my performance of any and all volunteer duties.
Photography Release: I agree to allow pictures of myself to be used, without compensation, for the purpose of the promotion and publicity related to Staffy Rescue.
Signature*

Clear
Date

MonthDayYear
Guardian's Signature

Clear
Should be Empty:

Staffy Rescue Volunteer Application

Volunteer Liability Release Form

I verify that all above details are true and correct