Have you been a CT resident for at least the last 5 years?
If no, please advise prior state/s you resided in:
Date of Birth Ex: 4/22/78
Emergency Contact Name
Emergency Contact Phone Number
Days You Are Available To Volunteer
How Many Hours A Week Are You Able To Volunteer? On What Days? Ex: Su - 8 Hrs, Tu - 4 Hrs
Are you able to commit to volunteering for a minimum of 6 months?
What area of the shelter would you prefer to volunteer? Ex: Dogs, Cats, Office, Fundraising, Marketing, Online offsite, etc...
Experience With Cats?
Experience With Dogs?
What Are Your Strengths? i.e. Computers, Construction, Arts, Bookkeeping etc.
Do You Have Any Allergies?
Do You Have Any Work Limitations? (ie. lifting, bending, mobility)
Have You Ever Worked In A Shelter/Rescue Environment? If So, Where? What Were Your Duties? Are You Still Active With Them? If Not, Why Did You Leave?
Community Service Applicants
Are You Looking To Fulfill Community Service Hours
How Many Hours Do You Need To Fulfill?
Are You Looking To Learn Anything Specific Relating To School? If So, What?
What Are Your Charges? (Please Note This Is A Required Field And Leaving It Blank Will Result In Automatic Rejection Of Your Application)
How Many Hours Do You Need To Fulfill?
The Court Where Charges Were Filed?
What Is Your Parole/Probation Officer's Name?
What Is Your Parole/Probation Officer's Phone Number?
What Is Your Parole/Probation Officer's Email Address?
Declaration For Court Mandated Applicants: I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false, untrue, misleading, or misrepresenting, I am aware that my application may be rejected.
Court Applicant Signature (Please use your finger or mouse to sign)
Volunteer Acknowledgment and Agreement
In acting as a VOLUNTEER for the Meriden Humane Society (Hereinafter "MHS"), I understand that my services are provided strictly in a voluntary capacity as a VOLUNTEER, and without any express and implied promise of salary, compensation, employment, benefits, including insurance programs, worker's compensation, accrual in any form, vacation, sick time, or other payment of any kind whatsoever.
1. I will familiarize myself and comply with MHS's policies and procedures applicable to volunteers.
2. I understand that in my VOLUNTEERING participation, it is expected of me to use reasonable judgement in communicating with MHS STAFF and other VOLUNTEERS on duty. I agree to minimize conflict, and to the best of my ability, resolve disagreements. If there are any issues that are unable to be resolved, it is MY duty to ASAP inform SHELTER STAFF or Supervisor.
3. MHS maintains high standards or moral and ethical treatment of the animals under its care; therefore, I will support and exercise these standards in my capacity as a VOLUNTEER.
4. As a VOLUNTEER, I understand that there are different animals on the premises; I must exercise the utmost care so as not to let any animal come to into harm's way of other animals.
5. If ever an animal is led away to an event off the premises by me, it is my sole responsibility to restrain and control it so as not to create any dangerous situation.
6. Since there may be potential safety risks of working with animals and bringing home illnesses from MHS to personal pets, I will practice reasonable healthy hygiene.
I have a current Rabies Vaccine
7. I understand that it is recommended for me to be current on my tetanus vaccinations.
8. It is advised that all VOLUNTEERS bring a minimal of personal belongings while on duty at MHS, there will not be any personal lockers provided, everyone is responsible for his or her own belongings. MHS and staff are not responsible for personal belongings.
9. VOLUNTEERS under 14 years of age require a parent or guardian to accompany them at all times at the shelter. Also, the volunteer's parent or legal guardian must sign forms prior to volunteering.
10. MHS reserves the right to revoke my volunteer status, at any time, for noncompliance of any of the above or for any reason they deem necessary.
11. I grant The Meriden Humane Society (“MHS”) the right and permission to use photographs and/or video recordings of me on MHS and other websites and in publications, promotional flyers, educational materials, derivative works, or for any other similar purpose without compensation to me. I understand and agree that I may be identified by name and/or title that might accompany the photographs and/or video recordings of me. I waive the right to approve the final product. I release and forever discharge MHS, its current and former Board of Directors, Employees and/or Volunteers from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation
12.The purpose of this agreement is to clarify and to enumerate certain obligations Board Members, Employees and Volunteers already have under the laws of the State of CT to the corporation as fiduciaries of the corporation.
Each Board Member, employee and/or volunteer of the Meriden Humane society shall keep confidential all information regarding doings of the establishment, including, but not limited to:
Discussions during meetings, Electronic mail communications, Financial information, Fundraising ideas, Communication of staff and volunteers, Meeting not attended by the public
Nothing in this section shall prohibit a volunteer, employee, or member of the Board from making any disclosures required by law. The Board only may, by a majority vote, decide to release otherwise confidential information to the public.
As a Board Member, Volunteer or Employee, I acknowledge receipt of these confidentiality expectations and agree to abide by them. I understand that failure to abide by them may result in expulsion from the Meriden Humane Society and other appropriate action
13. While I am on duty, during my VOLUNTEER periods at MHS, I will not keep company of guests, family, minors, etc. on premises.
14. Waiver of Liability for Services Performed On Site I hereby release and forever discharge Meriden Humane Society, its employees, directors, officers, administrators, agents, and assigns from all liability for any and all claims, demands, actions, causes of action or suits of any kind whatsoever, and particularly on account of any injuries, to person or property sustained while performing services, voluntary or otherwise, at the MHS facility located at 311 Murdock Ave, Meriden, CT 06450.
15. Waiver of Liability for Services Performed Off Site I hereby release and forever discharge MHS, and any off site organization from all liability for any and all claims, demands, actions, causes of action or suits of any kind whatsoever, and particularly on account of any injuries, to person or property sustained while performing services, voluntary or otherwise, on behalf of, or in conjunction with, MHS which occurs as a result of participation in any event or activity sponsored or endorsed by MHS, including, but not limited to , any event or activity promoted in connection with MHS or it's membership program and travels to/from any such event.
16. Waiver of Liability for Services Performed at the MHS and other Off Site Adoption Locations I hereby agree that I am providing volunteer services to MHS, assisting in pet adoptions. This may also include assisting in adoption of pets through MHS at local store or other off-site adoption locations. I understand that MHS, or other off-site adoption locations are not responsible for any illness or injury caused by any animals that I come into contact with during my volunteer work. I agree to hold Harmless and release from liability MHS and all other off-site adoption locations should I become sick or injured from any animal as a result of my volunteer work.
17. Responsibility for Personal Pets and Agreement to indemnify I agree that any injury, damage, or loss, of any kind whatsoever, to any person, animal, or property at any MHS event, or at the MHS facility, caused by my own pet, or a pet which is otherwise in my possession, is solely my responsibility and I will indemnify, save and hold harmless MHS from any damages, costs, losses and expenses including, but not limited to bodily injury, property damage, including but not limited to legal fees, court costs, and litigation expenses.
18. Responsibility to Report Injuries - I agree to immediately report all injuries or disease I may receive while on the property of the MHS facility or while working in the service of the MHS, including but not limited to animal bites, deep scratches, and slip and falls. I agree to file an incident report immediately following any such injury. If I am unable to file a written report, I agree to contact a Member of the Board of Directors within 24 hours of the incident to inform them of said incident.
19. Agreement of Indemnify - I further agree that if, despite the Release of Liability and Hold Harmless Agreement I or anyone on my behalf makes a claim against the MHS, I will indemnify, save and hold harmless the MHS from any damages, losses and expenses including, but not limited to, legal fees, court cost and litigation expenses. I agree to indemnify and hold harmless the MHS from any and all liability, damage, loss, cost and expense incurred as a result of any claim, demand or cause of action brought against the MHS, jointly or individually, for bodily injury, death or property damaged suffered as a result of my own negligent, reckless or willful act, omission in the performance of, failure to perform his/her volunteer services. (EXAMPLE: a volunteer is drunk driving a MHS van which then hits and kills a 3rd person. Estate of 3rd person sues MHS, the signer of this agrees to pay the judgement against MHS.)
20. Acknowledgements - Neither this waiver nor the circumstances leading to its execution shall be deemed acknowledgement by the MHS that, as of the date hereof, any such claim exists or will exist or that the activities and event of the MHS are hazardous or present any unusual risks. I acknowledge and agree that I: a) Fully understand the meaning of this release and waiver and recognize my right to seek the advice of an attorney before signing it; b) Have signed it freely and without any inducement or assurance of any nature; c) Intend it to be a complete unconditional release of liability to the greatest extent allowed by law; and d) Agree that if any portion of this agreement is held to be invalid the balance notwithstanding shall continue in full force and effect. This release is binding on my heirs, executors, assigns and administrators. The undersigned is aware of the risks of attending, traveling to and participating in said events or activities and hereby assumes all risks. The risks include those foreseen and unforeseen, known and unknown.
Volunteer Applicant Full Name
Volunteer Applicant Signature (Please use your finger or mouse to sign)
Applicant Signature Date
Guardian Full Name (if applicant under 18)
Guardian Signature (Please use your finger or mouse to sign)
Guardian Signature Date