Volunteer Form Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* EmployerJob TitleFacebook page Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Are you 18 years of age or older?*YesNoDo you have a Valid Driver’s License?*YesNoProvisionalPlease select the box next to all Volunteer activities in which you are interestedFor 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 OtherWhat 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 describePlease list anything else you would like to tell us about yourselfHow did you hear about us?Emergency Contact First Last Emergency Contact PhonePlease 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 takenNo, please do not use my photoUnfortunately 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 This iframe contains the logic required to handle Ajax powered Gravity Forms.