Volunteer Form - House with a Heart

Name*

First Last

Address*

Street Address City State ZIP Code

Phone*

Email*

Employer

Job Title

Facebook page

Date of Birth*

Are you 18 years of age or older?*

Yes
No

Do you have a Valid Driver’s License?*

Yes
No
Provisional

Please select the box next to all Volunteer activities in which you are interested

For HWAH Senior Dogs

Brush dogs, clean eyes and ears, give baths to the dogs
Take residents out for playtime.
Fundraising for special events

Maintain the sanctuary inside and outside and other misc. activities to support HWAH

Cleaning outdoor patios
Do laundry (towels and blankets for the dogs, etc.)
Clean inside HWAH (sweep, vacuum, dust, etc.)
Work in the HWAH yard (rake, weed, plant flowers, clean up the grounds, gather dog toys, mow small areas.)
"Poop scoop" the yards
Clean and disinfect litter boxes, vacuum and dust kitty rooms, play with cats, groom, feed and give fresh water

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?*

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Other

Other

What hours of volunteering are you available*

11-2 pm
Noon-2pm
Offsite researcher
Fundraising team

If you have prior experience working with dogs or cats 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

Unfortunately we live in a litigious society and one of our audit recommendations is to request that you sign a Release Form in order for you to volunteer at our Sanctuary.

By signing 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 and cats 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