date-==. - Harvest Hills Animal Shelter

Harvest l{ills Animal Shelter, Inc.
1389 Bririgton Eoad - Fryeburg, Maine 04fi37
Yolunteer Application
Date
Name
Address
State
City
zip
Telephone Day
Evening
Birthdate
Why would you like to be a volunteer at Haryest Hills Animal Shelter?
Is your volunteer service court ordered?
NO
Yes
When are you available to volunteer?
) I Friday (time
[ ] Monday
) I Saturday (time
[ ] Tuesday
I Sunday (time.
[ ] Wednesday (time------------)
)
[] Thursday
What type of activities would you like ta share?
_ Socializing catslkittens Sociaiizing dogs/puppies
_ Fund Raising
Outdoor work details
_Indoor work
_ Shopping
Grooming
_ Thrift
_Maintenance
_ At-home projects
_ Education (schools) Coin Canisters
(time
(time
(time
details
Shop
MEDICAL
-
-
Have you had a tetanus shot within the last 10 years? (recommended) [ ] no [ ] yes
date-==.--
-
Have you ever had rabies shots? [ ] no[]yes-date.
Do you have any allergies? [ ] no [.I yes - specify
Do you have medical insurance? [ ] no[]yes
In case of emergency, please
notifli:
Phone
understand that"handling animals does involve some risk and thatHarvest Hills Animal
Shelter, Inc. is not liable for any injury I sustain while I am a volunteer at the Shelter. In
the event of an emergency,I hereby give my permission for the person in charge at
Harvest Hills at the time of the emergency to see that I arn brought to the emergency
room at the Bridgton Hospital in Bridgton. At that time, medical personnel will secure
proper treatment for me.
I have read and understand the Halest Hills Animal Shelter,Inc. documents entitled
"Volunteer and Safety Policies" and agree to abide by these policies.
I
Signature
Date
HHAS Approved by
Date