First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Country

Email*

Home Phone*

Work Phone
x

Cell Phone*

County*

Facebook Profile URL (if none, write N/A)*

Are you over the age of 18? *

Car Description (Make, Model, Year & Color) *

Emergency Contact - Name *

Emergency Contact - Phone Number *

Emergency Contact - Relationship to You *

Please list name and Phone number of 3 personal references.*

List any other rescue groups you are associated with or type of experience volunteering/working with animals, fundraising or other relevant experience.*

Distance willing to travel to a neglect site to offer assistance*

Check any boxes below for areas you have experience with or would like to help wit

When are you available? Check all that apply

Are you available short notice?*

Do you work in law enforcement?*

If yes to the previous question, what department do you work in and which areas do you cover?

Are you a Humane Officer?*

If yes to the previous questions, which county(s) do you cover?

Are you interested in taking the class and becoming a Humane Officer for your county? *

I (print name) born on (Date) fully understand and agree to assume any and all risks involved in any and all duties that I perform for One Dog At A Time, also known as ODAAT in my capacity as a volunteer for this organization. Here in after jointly known as RESCUE. I understand and agree to hold RESCUE harmless for any injury or injuries which I may sustain during the course of my volunteer duties for RESCUE including, but not limited to: the risks of being bitten, scratched, injured, or frightened by cats, kittens, dogs, and puppies or any animal under my care as a volunteer for RESCUE. I understand and agree that RESCUE is not liable for any injuries, damages, liabilities, losses, judgments, costs, or expenses whatsoever that I may suffer or sustain in connection with the performance of my volunteer activities unless they are the result of RESCUE gross negligence (defined as: a carelessness and reckless disregard for the safety or lives of others, which is so great it appears to be almost a conscious violation of other people's rights to safety) or intentional misconduct. I will indemnify, defend, and hold RESCUE harmless from and against any claims, lawsuits, injuries, damages, losses, costs, or expense whatsoever sustained by any companion animal or any person in connection with my intentional misconduct or grossly negligent performance of volunteer activities for the RESCUE or with my breach of RESCUE’s rules, regulations, policies, and programs. If I will be sheltering or providing foster care or boarding for any RESCUE animals in my home or business, I consent to RESCUE visiting my home or business from time to time to observe the animals and their living quarters. I also agree that these visits may be unplanned or unscheduled prior to the actual visit. This Hold Harmless Agreement will forever prevent me from seeking any legal actions whatsoever against the RESCUE organization or any of its representatives. If you agree to the above please enter your Date of Birth, name and that you agree to the terms of the Hold Harmless Form.*

By filling out this volunteer form, I agree to and understand these rules of One Dog At A Time as presented above. By electronically signing below, I release One Dog At A Time from any liability should I be injured or have my property damaged while volunteering. I also agree that if at any time I break any Pennsylvania laws, I will be personally held accountable for my actions.

Upon approval as a volunteer, I agree to read any training or educational material sent to me before visiting any sites and will ask for clarification should I have any questions regarding the material sent.*

By signing below I acknowledge that I have never been charged with animal abuse (misdemeanor or felony) nor have I had any legal citations brought against me involving animals in my care. I also acknowledge that I have never been charged with a felony or proven guilty of a misdemeanor (besides minor traffic violations) in a court of law. I agree to disclose any information regarding my criminal history to a Board Member of ODAAT and agree that a decision will be made about the impact of my ability to volunteer. I also agree to inform the ODAAT Board Members should there be any change in my criminal record*