Date of Birth*
Emergency Contact Phone*
Relationship to Emergency Contact*
What types of help would you like to provide (training/grooming/fostering/dog handling/fundraising/community service/etc.)?*
Do you have professional experience working with animals? if so please explain.
Have you done volunteer work in the past? If so, please explain.
Do you posses any special skills or experience that you think would be helpful? If so, please explain.
How did you hear about us?
Waiver of Liability and Agreement to Indemnify
1. VOLUNTARY ACKNOWLEDGEMENT AND PARTICIPATION. I acknowledge that I have voluntarily agreed to serve as a volunteer for Canine Companions Rescue Center (“CCRC”), a nonprofit corporation organized under the laws of the State of Michigan. I am referred to as a “Volunteer.” I offer to perform as a Volunteer of my own volition.
2. NATURE AND SCOPE OF SERVICES. As a Volunteer, I will be contributing my time and effort to various rescue and outreach programs of CCRC and performing a wide range of Services (collectively, the “Services”). The Services will be performed by me as assigned by an officer, director, employee or another volunteer of CCRC. In the course of performing the Services, I agree:
• To read the Volunteer Handbook and the Foster Handbook (if applicable) and otherwise complete all required orientation, training, and paperwork relating to my volunteer position(s).
• To disclose any physical or psychological limitations to appropriate staff before participating in any activity. Since I may be interacting with animals, both healthy and sick, big and small, and may be lifting, carrying, moving, or otherwise engaging in physical labor, I will be respectful of my own limitations and will inform staff immediately of any such limitations.
• To read and to obey all safety rules and regulations, especially at Canine Companions Rescue Center. In the interest of the safety of the animals, staff, and volunteers, I acknowledge that CCRC has the right to revoke volunteer privileges if these rules and regulations are not followed.
• To treat all CCRC staff, volunteers, the animals, property, tools, and equipment with respect and kindness. I will also return all CCRC property when my volunteer relationship ends.
• That either I or CCRC can terminate this relationship at will.
3. NO COMPENSATION. I agree to provide my Services without compensation. I will not be compensated for my efforts nor am I an agent or contractor of CCRC. I agree that I am not and will not become an employee, partner, agent, contractor or principal of CCRC upon execution of this agreement or the performance of the Services.
4. RESPONSIBILITY FOR MY OWN ACTS AND OMISSIONS. I hereby agree to be legally and financially responsible and will indemnify and hold CCRC harmless for my own acts and omissions relating to the service I am voluntarily providing to CCRC. I acknowledge that I am responsible for providing my own medical, liability, and auto insurance during my volunteer service. I understand that I am not covered by workers’ compensation nor insured by CCRC during the performance of my volunteer duties and tasks, including when driving a vehicle or transporting an animal.
5. ASSUMPTION OF RISK. I am voluntarily participating in the activities of CCRC with full knowledge of the risks and dangers involved and hereby agree to accept any and all risks of injury, death, or damage to myself and/or my personal property. As a volunteer, I may come into contact with and interact with animals, and such work entails risk of personal injury due to proximity to animals, dangerous equipment, long-distance driving, and other considerations. These include, but are not limited to, being bitten, kicked, clawed, tripped, and possibly exposed to zoonotic diseases.
6. PHOTO, VIDEO AND AUDIO RELEASE. I understand that as a volunteer of CCRC, I may be recorded on film, video or other electronic recorded images or other media recordings of my name and likeness (“A-V Recordings”) for any purpose related to furtherance of the objectives of CCRC, including use in CCRC media properties such as its magazine and websites. In particular, I grant CCRC permission to copyright and use, reuse, publish, and republish A-V Recordings, without restriction as to changes or aIterations, for art, advertising, trade, or any other purpose. Further, I understand that all work product I create in my capacity as a volunteer for CCRC will be the property of CCRC and that CCRC will have the sole right to use, sell, license, publish, or transfer any such work product, in any and all media formats, including print, mechanical and electronic formats. I will disclose any such work product to CCRC and assign all rights thereto to CCRC.
7. RELEASE. As consideration for being permitted by CCRC to participate in activities and provide Services, I hereby agree that I, my assignees, heirs, distributees, guardians, and legal representatives will not make a claim against, sue, or attach the property of CCRC for injury or damage resulting from any act, omission, negligence or other acts, howsoever caused, by any employee, agent, contractor, or representative of CCRC as a result of my participation in activities and performance of the Services and any A-V Recordings. I hereby release CCRC from all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in activities and performance of the Services and any A-V Recordings.
8. CONFIDENTIALITY. During my association with CCRC and thereafter, I will keep confidential, refrain from disclosing to others, and use only in the performance of my volunteer duties, all confidential information of CCRC that I develop or learn about during the course of my association. I understand that this agreement covers all confidential business and technical information and know-how of or about CCRC which is not generally known to persons outside of CCRC and which I have not been specifically authorized to disclose or use. Examples of confidential information include, but are not limited to, information on finances, membership and donors, volunteer performance, research and development, the condition of animals, campaigns, outreach programs and information received from others that CCRC has agreed to keep confidential.
9. I HAVE READ THIS RELEASE AGREEMENT AND FULLY UNDERSTAND THAT I WILL RELINQUISH ALL CLAIMS OR ACTIONS KNOWN NOW OR IN THE FUTURE AGAINST CCRC. I am of legal age and legally competent to sign this agreement. I am signing this agreement of my own free will without the influence of a CCRC staff member.
11. TERM OF AGREEMENT. I acknowledge that this agreement will apply to the entire term of my volunteer relationship, starting with the date I first perform volunteer duties for CCRC, even if it pre-dates the date of this agreement, and continuing as long as I continue to be a Volunteer and thereafter as is necessary to protect the interests and rights of CCRC arising herein with respect to confidentiality and use of my work products and/or A-V material as authorized above.
By typing my name into the box below, which will serve as my signature, I acknowledge that I have read, understand and will follow all items listed above, as well as the safety rules for all areas in which I volunteer, including, but not limited to, all CCRC animal areas.
Please Type Name (this will serve as your signature)*
What types of dogs/pups would you prefer to foster?
How will you contain your foster inside when you are not directly supervising?
How will you contain your foster outside?
Do you have the means to transport your foster to adoption events and vet appointments?
Are your current pets ok with other animals?*
PLEASE LIST YOUR CURRENT PETS
Type of Pet
Up to date on shots?