Volunteer Form * required information Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Employer* Job Title* Facebook page Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Are you 18 years of age or older?* Yes No Do you have a Valid Driver’s License?* Yes No Provisional DUTIES INCLUDEPlease check all that you're interested in.For Dogs Brush dogs, clean eyes and ears, give baths to the dogs Take residents out for playtime. Walk dogs Poop scoop yards Maintain the sanctuary inside Clean inside HWAH (sweep, vacuum, dust, mop etc.) Refresh water bowls Empty trash and recycling Clean dog door flaps Kennel Assistant Feed Short Term Care dogs Refresh water bowls Take them out to do business Neaten their pen area Poop scoop their yard Set up their food for next meal Maintain the sanctuary grounds Cleaning outdoor patios Refresh outside water bowls Work in the HWAH yard (rake, weed, plant flowers, clean up the grounds, gather dog toys, mow small areas.) "Poop scoop" the yards Sweep outdoor stairs How often are you interested in Volunteering at HWAH?I would like to volunteer* Once a week Twice a month Other (list below) How many hours a month do you want to volunteer?*What days are you available to volunteer?* Monday Tuesday Wednesday Thursday Friday Saturday Other OtherWhat hours of volunteering are you available* Noon-2pm Kennel assistant 5-7pm (summers only) If you have prior experience working with dogs as part of your job experience or as a Volunteer, please describe*Please list anything else you would like to tell us about yourself*How did you hear about us?*Emergency Contact* First Last Emergency Contact Phone*Please Note: Photos will be taken from time to time and some photographs will be posted on our web site, FB and newsletter. Please let us know if you do not wish to have your picture made public.* Yes, you can use any pictures taken No, please do not use my photo By typing your name below on this Liability Release Form, I acknowledge that it is possible that I could be bitten/scratched or otherwise hurt by a Sanctuary or temporary foster pet, or could in some other way be injured while performing volunteer services at House With A Heart Pet Sanctuary, Inc. (HWAH).** I understand the nature of dogs is such that it would be impossible for HWAH/ Sherry L. Polvinale to predict if a pet may scratch or bite or otherwise injure me. I understand that I could become injured while performing volunteer duties and I consent to waive any and all claims against HWAH/Sherry L. Polvinale for any such incident should it occur. (Type name below.)* Δ
