Volunteer Application First Name * Last Name * Address * City * State * AL AK AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip/Postal Code * Home Phone Number * Work Phone Number Cell Phone Number Email Address * Are you 18 or older? * How did you hear of the PLR Volunteer Program? * If you are here through a volunteer program, please indicate the following: Agency, Address, Name of Contact Person, Telephone. * Why do you want to volunteer with PLR? * Have you had any formal education/training in pet care or animal welfare? If so, please list the following: Where, when, type of education/training. * Have you done any other volunteer work? If so, please list the following: Where, when, type of work performed. * Please list in what capacity you would like to help PLR: Canine care, marketing, fundraising, medical care, foster care, other (please be specific). * Do you know any PLR volunteers? If so, please state the name and relationship. * Have you adopted an animal from PLR? * Choose one: Yes No If you answered yes to the previous question, who did you adopt and when? Use N/A if you answered no. * Are you a member of any other animal welfare organization? * Choose one: Yes No If you answered yes to the previous question, which organizations and how do you participate? Use N/A if you answered no. * Please list below the days and times you're available. Only for canine care (i.e. walking, bathing, etc.) and events. * Do you have any allergies or conditions that might affect your volunteer work? * Choose one: Yes No If you answered yes to the previous question, please describe. Use N/A if you answered no. * Do you have a valid driver's license? * Choose one: Yes No Please list two personal or business references, including name, contact information, and their relationship to you. * Please list an emergency contact, including name, contact information, and their relationship to you. * Terms of Agreement If accepted as a PLR volunteer, you will be required to abide by the terms of our Volunteer Agreement. The agreement below details what PLR will expect of you and what you can expect from PLR. If accepted as a PLR volunteer, my electronic signature and date stamp below indicates that I have read, understand, and agree to the following: • I will treat all animals and other volunteers with respect and I will work as a team member with all volunteers. • I will abide by all PLR policies and procedures and follow the directions/instructions of the PLR Founder and members. • I agree to be supervised by the appropriate members and will report any problems that arise directly to the appropriate member and the Volunteer Coordinator. • I understand the possible risk of bringing home illnesses to personal pets or vice versa and must have current vaccinations for animals at home. • I understand the potential safety risks of working with animals and that I may not bring friends or relatives with me while volunteering for PLR. • I am current on my tetanus vaccination and covered by a health insurance plan. • I understand that PLR relies on me to be present for all of my scheduled commitments. If I am unable to fulfill my commitments, I understand that it is my responsibility to arrange for a substitute for those commitments. In addition, I will also provide advance notice to the appropriate member and the Volunteer Coordinator of any such changes. • I authorize PLR to seek emergency medical treatment for me in case of accident, injury, or illness. • I agree to indemnify and hold harmless PLR, its Board of Directors, officers, agents, and members from and against any and all liability whatsoever arising out of or related to my duties under this agreement or for any negligent act or omission by PLR, its Board of Directors, officers, agents, and members. • If I fail to abide by the terms of this Agreement or am otherwise unable to meet the requirements of the volunteer program, which are subject to change by PLR from time to time, I understand that I will be terminated from the program. I also understand that I may at any time be removed from my position as a volunteer at the sole discretion of the Founder, Volunteer Coordinator or other members. Please enter your electronic signature and date stamp indicating that you have read, understand, and agree to the above terms. *
