Kennebec Valley Humane Society
Volunteer Application


 

Name:  Date of Birth: 
Address:  Home Phone: 
City:  
State:  
ZIP: 		Email: 

Please list previous volunteer experience:
Please list any experience you've had in animal, veterinary or medical work:
Additional skills and/or experience you have that you would be willing to share with the Humane Society:

Can you cope with euthanasia? (You will NOT be required to witness euthanasia.)         Yes or No

Do you have any personal goals for volunteering at this shelter?

Do you have any pets?    Yes or No If so, what kind? 

What types of volunteer jobs are you interested in? (Please check.)
Special Events Kennel Technician Work
Behavioral Help Line Committee Work
Grooming and bathing animals Pet Therapy Program
Receptionist duties Building/ground maintenance
Transporting animals Foster Pet Program

Please list any restrictions which could affect your availability for volunteer work (such as family, work, schedule, school, physical disabilities, etc.):

Please list all times that you would be able to work (keep in mind that you will not be required to work all the times that you are available.)
Monday: Thursday:
Tuesday: Friday:
Wednesday: Saturday:

How long do you expect to be able to volunteer with the KVHS?  

 

Please list 2 references (other than family members) that we may call:

Name: Phone:
Name: Phone:


Allergies:

Special Medical Conditions:

Do you have health insurance?   Yes or No Company:
Policy #:


In case of emergency, please notify:

Name: Relationship:
Address:
Telephone:
   
Physician:
Address:
Telephone:


In the event of an emergency, I hereby give permission to the physician selected by the KVHS to hospitalize, secure proper treatment for, and order injections and/or anesthesia and/or surgery for me.

I hereby agree that the KVHS shall not be held responsible for any injury, accident, and/or sickness to me which may occur in connection with the volunteer program.

 

Signature: Date: