Pet Central Helps! Volunteer Velocity Program

All new volunteers are required to complete this volunteer survey and attend a Volunteer Orientation. Children 12-16 have animal handling limitations and are required to volunteer with a parent (both parent and child are required to complete an application, attend the volunteer training and volunteer together). Persons 16 and older can volunteer without a parent but must have a parent's signature for permission.

Special Needs Volunteers and Volunteers: People with special needs are welcome to volunteer (if you have a caregiver we ask they accompany you while working with the pets)

Students and Groups have leader complete form and check group box.

Name: *

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If you are under 16, name of adult volunteering with you:

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Date of Birth: * +

Address Line 1: *

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Address Line 2:

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City: *

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State: *

Zip Code: *

Home Phone:

Cell Phone:

Work Phone:

Email: *

Choose One: *

Employed

Retired

Other

If employed or retired, name your workplace?

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Do you have a group that would like to volunteer? *

Yes

No

Please list any previous volunteer experience: *

Do you currently work or volunteer for another animal welfare organization? *

Yes

No

Do you have any disabilities that need to be accommodated? *

Yes

No

If yes to the above question, please explain:

Do you own any pets? *

Describe any experience you have working with animals: *

Have you been convicted of a felony within the last 7 years? *

Yes

No

If you answered yes above, please explain:

IN CASE OF EMERGENCY, PLEASE CONTACT: *

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EMERGENCY CONTACT PHONE: *

Parent or Guardian Name if Volunteer under 18:

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Waiver and Relase of Liability:

Waiver and Release of Liability, Indemnification and Hold Harmless Agreement This waiver and release of liability, indemnification and hold harmless agreement is between the Volunteer and Pet Central Helps, 360 Wylie Drive, Normal, IL 61761, McLean County, IL and its directors, officers, employees, agents, assigns, legal representatives and successors (hereinafter referred to as PCH). As a volunteer that is 18 years old or older, I hereby understand and agree to the following: I agree to WAIVE and RELEASE the PCH from all liability, manner of actions, causes of action, debts, contracts, claims and demands for or by reason of any illness, death, damage, loss or injury to person and property, which has been or may be sustained as a direct or indirect consequence of the Volunteer's volunteering at or for the PCH and notwithstanding that such damage, death, illness, loss or injury may have been caused partly by the negligence of the PCH. I agree to INDEMNIFY and HOLD HARMLESS the PCH for any costs or liabilities which they may incur as a result of my volunteering at or for the PCH. I hereby give the PCH the unrestricted right and permission to copyright and use, re-use, publish, and republish photographic pictures of me and my pet, or in which I may be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade or any other purpose whatsoever. I acknowledge and agree that I have carefully read this Agreement, that I fully understand the same, and that I freely and voluntarily execute the same. I understand that I may seek independent advice prior to signing this Agreement. I understand that this Agreement is binding on me, my spouse, my executors, administrators, personal representatives and assigns and that this Agreement has important legal consequences. The terms of this Agreement are contractual and non mere recitals. This Agreement will be construed in accordance with and governed by the laws of the State of Illinois.

Waiver: *

I have read and agree to the above

How did you hear about us? *

Signature of Parent or Guardian: *

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What are you most interested in helping Pet Central Helps with? *

Fostering

Caring Paws (fostering a pet for people in our community in a crisis need)

Adoption Events

Bathing/Grooming (this won't begin until space is completed)

Walking/Exercising/Enrichment of the animals (this won't start until the facility is completed)

Help Desk (crisis solving solutions)

Computer Work (general typing)

Greeting Visitors

Please enter anything else you might want us to know about yourself:

Friends or Family Member	Church	School	Social Media
Our Website	Volunteer Match	Social Service Agency	Petfinder
Other