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Little Buckets Farm Sanctuary Minor Volunteer Application for those 17 and Younger
Located in Brodnax, VA closer to Lawrenceville
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Email *
Applicant Full Name *
Home Address *
City/State/Zip *
Home and/or Mobile Phone Number *
Driver's License (State/Number) if applicable. If under 16, please type N/A. *
What is your age range? *
Are you willing to work any day, including weekends? *
If you are not willing to work any day, including weekends, please state any limitations. *
What is your preferred day(s) of the week to volunteer? (Check all that apply) *
Required
How many hours a week are you interested in volunteering? *
How many times a week are you interested in volunteering? *
What is your preferred time slot for volunteering? *
Required
What date are you available to begin volunteering? *
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Please list a non-relative who would be willing to provide a reference for you if over 16. Please include their name, phone number, and relationship to you. If 15 or younger, please type n/a. *
Do you have any allergies/medical conditions? If so, please list. *
Are you able to lift, carry, push, and pull up to 25 pounds *
Are you able to stand and walk up to 4 hours? *
Are you able to work in all weather conditions? *
Any special skills or trades? *
Please provide any other information you would be willing to share! *
Why are you interested in volunteering? *
Who is your parent you will be coming with? Parents are required to volunteer with those 15 and younger. For those 16 or 17, a parent will be required to attend up to the first 3 times your child volunteers. *
What is your Birthday? Month and Day Only *
What is your Tshirt Size? *
Being Vegan is not a requirement of our sanctuary, however we do ask everyone who volunteers to be willing to have an open mind as well as be respectful of the animals on the farm by watching the conversations you have as well as the food you bring with you. *
When posting pictures of volunteer activities on our social media channels, do you want to be tagged? *
Please provide your Facebook and/or Instagram Handle Names:. Type N/A if you are not on social media. *
Volunteers are reminded that confidential financial, personnel and other matters concerning the organization, donors, animal's health or other information may be discussed from time to time. Volunteers should not disclose such confidential information to anyone, unless required by law *
If taking videos/pictures of the farm and animals and you want to post them on your social media - please only post images/videos that show off the animals and the farm in a positive and healthy light. (for example if someone has an irritated eye or flies on their face, please do not post this image or if someone decides to take a nap in or near a pile of poop, then do not post this image.) Also, please keep the house on the property out of images/videos when possible. Please always tag us by typing @littlebucketsfarmsanctuary in your description. We should pop up as a choice. *
Minor Volunteer Assumption of Risk, Indemnity, and Release of All Claims Thank you for volunteering at Little Buckets Farm Sanctuary.  We appreciate that you have chosen to spend time with us. Before you begin, we need you to know that volunteering on our Sanctuary can expose your child to personal injury or damage to your minor child’s property. This waiver outlines our respective rights and responsibilities relating to that risk. Please read this waiver carefully and let us know if you have any questions.  


To further its tax-exempt purposes, Little Buckets operates a farm and animal sanctuary (the “Sanctuary”).   Little Buckets is dedicated to giving animals a safe and loving home they all so deserve.  Little Buckets is a nonprofit 501c3 vegan sanctuary.  Little Buckets shows the public how Sanctuary animals have loving, fun, sweet personalities, have strong family bonds and friendships, and that they feel the same emotions as your domestic pets. We show there is no difference and that we should love all animals by living compassionately.

I. VOLUNTEER STATUS
I would like my minor child to volunteer in farm activities at Little Buckets Sanctuary (the “the Sanctuary”). I understand that as a volunteer my minor child will not be paid for his/her efforts and will not be covered under workers compensation insurance. Because my child is a minor, the Minor Volunteer Assumption of Risk, Indemnity, and Release of All Claims will be signed by me, in my capacity as the parent or guardian of a minor child.
 
II. RISKS OF VOLUNTEERING
I understand that the activities at the Sanctuary involve serious risks, physical labor, exposure to hazardous conditions, or other circumstances that may result in personal injuries. My minor child may be exposed to, for example, but not limited to: insects; wildlife; Sanctuary animals; inclement weather; extreme temperatures; heavy machinery; tools; the actions and negligence of employees, volunteers, and other people present on the Sanctuary; and dangerous conditions on the land such as holes in the ground or wire fences. I understand that these examples are not all-inclusive and there may be additional risks, all of which may involve serious personal injury, death, or damage to my or my minor child’s property.  
 
III. ASSUMPTION OF THE RISK
I and my family, heirs, and personal representatives agree to assume all of the risks and responsibilities of my minor child’s participation at the Sanctuary. I understand that I am solely responsible for any hospital or other costs arising out of any personal injury or property damage relating to my minor child’s participation at the Sanctuary.  I certify that I have health insurance for my minor child, and I agree to be financially responsible for any medical care costs and treatment arising while my minor child is volunteering at the Sanctuary.

IV. RELEASE OF CLAIMS AND INDEMNITY
I and my family, heirs, and personal representatives willingly and knowingly release the Sanctuary, Susan Klingenberg, and its officers, owners, employees and agents from any and all liability for any personal injury or damage relating to my minor child’s participation.

In exchange for the opportunity to participate in activities on the Sanctuary, I agree to indemnify and hold harmless Little Buckets and Susan Klingenberg, its related entities, partners, agents, officers, directors, employees, attorneys, heirs, successors, and assigns from and against any and all claims, losses, damages, judgments, settlements, costs and expenses (including reasonable attorneys' fees and expenses), and liabilities of every kind incurred as a result of:  (i) any act or omission by Little Buckets and Susan Klingenberg, or its officers, directors, employees, or agents; for any personal injury or property damage I or my minor child may incur as a result of my minor child’s participation at the Sanctuary.  This indemnity shall require the payment of costs and expenses by the parent/guardian of the minor child as they occur.  This section shall survive any termination or expiration of this Agreement.

V. MEDICAL CARE AUTHORIZED
I certify that my minor child is physically fit to participate in activities at the Sanctuary. I have disclosed any and all allergies or relevant medical conditions of my minor child to the Sanctuary on the Volunteer Information Form. I agree that the Sanctuary is not responsible for administering medical treatment of any kind. I understand that there are no medical services available on site or otherwise, and I give permission to the Sanctuary to authorize emergency medical treatment for my minor child. I release the Sanctuary and its officers, owners, employees and agents, from liability for any injury or damage that might extend from such emergency medical treatment for my minor child.  In the event of an emergency, please contact the following person(s) in the order presented:

VI. PHOTOGRAPHIC RELEASE
I agree to grant and convey irrevocably all right, title, and interest in any and all photographic images, and video and audio recordings of my minor child made by the Sanctuary during volunteer activities at the Sanctuary and I give permission to the Sanctuary to use these images or recordings in any way made by the Sanctuary during volunteer activities at the Sanctuary.

VII. CONFIDENTIALITY

I acknowledge and agree that I will be permitted to utilize Little Buckets’ name for the sole and limited purpose of promoting the Sanctuary and I warrant that I will not release any confidential information about the Sanctuary.

VIII. SEVERABILITY

I further agree that this waiver should be interpreted as broadly and inclusively as Virginia law permits.   The illegality or invalidity of any provisions of this Minor Volunteer Assumption of Risk, Indemnity, and Release of All Claims shall not impair, affect, or invalidate the other provisions of this agreement.


 Emergency Contact - Contact Name(s) *
Emergency Contact - Relationship to you *
Emergency Contact - Address (including city/state/zip) *
Emergency Contact - Daytime/Evening Phone Number *
BY SIGNING BELOW as the PARENT/GUARDIAN to the child listed under Applicant Full Name above (By typing your name), I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THE ELECTRONIC MINOR VOLUNTEER ASSUMPTION OF RISK, INDEMNITY, AND RELEASE OF ALL CLAIMS ABOVE AND THAT I UNDERSTAND AND AGREE TO ALL OF ITS TERMS AS OF THE DATE ENTERED BELOW.  I consent to use electronic records and signatures and I agree that this electronic signature is the equivalent of my manual signature. *
Please type today's date: *
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Thank you so much for wanting to volunteer and helping rescue the rescuer! We will be in touch with you about scheduling your first time to the farm. If you do not hear from Susan within a few days of filling out an application, please don't hesitate to email her at littlebucketsfarmsanctuary@gmail.com
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