First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Are you over 18?

What is your birth date?

Who is your current employer?

What is your title/position at work?

Have you volunteered for any other groups previously? If so, please list the Name of the organization, your role, length of time you volunteered and your reason for leaving.

Our rescue relies on many different types of volunteers. Please let us know which areas you want to help with.
Choose all that apply: Animal Care and Feeding Cleaning Data Entry Event Organization/Planning Fundraising Grant Writing Overnight Foster Photography/Video Social Media Transport Walks and Excursions

Please list any special skill sets you have.

How long are you interested in volunteering for us?

Please describe your experience working with animals.

Please describe your previous experience working with the public.

Please list any medical conditions or concerns we need to be aware of.

Have you ever been convicted of a felony?

Volunteer Release and Waiver of Liability Form

This Release and Waiver of Liability (the “release”) releases NikaPower Inc., dba The Rescued Pup (“Nika”), a nonprofit corporation organized and existing under the laws of the State of California and each of its directors, officers, employees, and agents. The Volunteer desires to provide volunteer services for Nika and engage in activities related to serving as a volunteer.

Volunteer understands that the scope of Volunteer’s relationship with Nika is limited to a volunteer position and that no compensation is expected in return for services provided by Volunteer; that Nika will not provide any benefits traditionally associated with employment to Volunteer; and that Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Volunteer’s services to Nika.

1. Waiver and Release: I, the Volunteer, release and forever discharge and hold harmless Nika and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to Nika. I understand and acknowledge that this Release discharges Nika from any liability or claim that I may have against Nika with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to Nika or occurring while I am providing volunteer services.

2. Insurance: Further I understand that Nika does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance. I expressly waive any such claim for compensation or liability on the part of Nika beyond what may be offered freely by Nika in the event of injury or medical expenses incurred by me.

3. Medical Treatment: I hereby Release and forever discharge Nika from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with Nika.

4. Assumption of Risk: I understand that the services I provide to Nika may include activities that may be hazardous to me including, but not limited to handling animals, walking, standing, bending over, holding a leash, grooming, repetitive motion, being exposed to zoonotic illnesses, parasites, fungi, lifting living and non-living things, exposure to cleaners, involving inherently dangerous activities. As a volunteer, I hereby expressly assume the risk of injury or harm from these activities and Release Nika from all liability.

5. Photographic Release: I grant and convey to Nika all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by Nika in connection with my providing volunteer services to Nika.

6. Other: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of California and that this Release shall be governed by and interpreted in accordance with the laws of the State of California. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected. By signing below, I express my understanding and intent to enter into this Release and Waiver of Liability willingly and voluntarily.

Type Name As Signature To Agree To Volunteer Release of Liability (Or Parent/Guardian if under 18)*

Date*