HEART Volunteer Form and Release

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If a question below applies to you, answers are required, even if not starred. HEART volunteers mainly work in the Cary and central Raleigh area, although we do have some volunteers who live further out. Driving time to events needs to be considered if you wish to volunteer with us, as an hour drive can limit activity (you may want to look for an organization that is closer to where you live).

Email *

Date: *

YYYY

Full Name *

Address: Street, City, State, Zip Code *

Phone 1: *

Phone 2:

Email: *

Age: *

Are you employed? *

Yes

Student

Retired

Other:

Ways I'd like to volunteer: *

Dog fostering (will require a foster survey form approval)

Meet and Greet event volunteer

Animal transporter

Pack Walks

Dog training

Dog Grooming

Special Projects (I will plan and implement)

Christmas Wreath at holidays

Required

I need to complete court ordered community service hours. *

Yes

I need to complete volunteer hours for school or other organization. *

Yes

I'd like to foster:

Puppy

Litter of puppies

Bottle feeder puppies

Adult dogs

Special needs dogs

Senior dogs

Please describe your previous experience with dogs: *

If you have any comments you'd like to add, please use space below:

Release from liability: I understand that my participation with Heaven and Earth Animal Rescue Team (HEART) is on a volunteer basis. Although HEART attempts to maintain a safe environment for volunteers, I acknowledge there are risks associated with working with animals including but not limited to bites, scratches, property damage, injury to personal pets and allergic reactions. In addition, I expressly acknowledge such risks and further agree to hold HEART harmless and release HEART from any and all claims for potential injury and/or liability that may arise out of being exposed to such risks. Typing your name below is a digital signature:

If a volunteer is under 18 years of age or up to 26 years of age and parents/legal guardians still cover cost of insurance, a parent or legal guardian must sign the form as well for release from liability. Typing name below is a digital signature for parent or legal guardian:

Phone number of parent or legal guardian:

Email address of parent or legal guardian:

A copy of your responses will be emailed to the address you provided.

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