Volunteer application
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MID-ATLANTIC PUG RESCUE 2640 Avent Ferry Road Holly Springs, NC 27540 (919) 557-3075 www.midatlanticpugrescue.org
VOLUNTEER APPLICATIONVolunteer Name: Volunteer E-mail: Volunteer Address: Volunteer Phone (work, home, cell): Volunteer Driver's License # and State: Why do you want to help MAPR? How are you able to help MAPR? (Check all that apply) ____Foster Home* ____Publicity/Marketing ____Transport ____Administrative ____Home Visits ____Reference Checking/Making Phone calls ____Events, Meet & Greets ____Graphic Design ____Fundraising ____Website Design ____Arts & Crafts ____Research ____Sewing ____Other (please explain)
Do you currently own any pets? YES NO If yes, list: Breed Temperament Gender Age Spayed/Neutered (Provide reason if not altered) What Is Your Occupation? Name and address of employer: Work hours: How long with this firm? If Less Than 1 Year where were you previously employed?
If yes, please give company name, address, phone number, and work hours below. Have you or anyone in your immediate family ever been convicted of a charge of or related to cruelty to animals? Yes No Is any such charge currently pending? Yes No Please provide the following two references: Veterinarian name: Address: Phone #: Date and reason of last visit: Name, address, phone number of a local individual (NOT a relative) who knows/has known your pets:
How far or long are you willing to drive one-way? Do you have a method of restraining dogs in your car? Yes No Please explain: Have you had any moving violations in the past 12 months? Yes No Please explain:
Are you comfortable visiting people you have never met for the purpose of approving them to adopt? Yes No Are you comfortable answering questions about the breed and rescue issues for potential adopters? Yes No
Do you have a pug you can bring along with you? Yes No Are you able to politely but firmly point out things to a homeowner that may injure a pug in the house/yard? Yes No Can you suggest things that will make an adoption go smoother? Yes No Are you comfortable following MAPR guidelines for home visits and filling out the requisite follow-up paperwork? Yes No
If there are other ways you can think of to assist MAPR, any and all ideas are appreciated! __________ Signature of Applicant Date VOLUNTEER LIABILITY RELEASE AND WAIVER FORM This volunteer agreement (“Agreement”) is entered into as of the date set forth above, by and between the person(s) named below and the Mid-Atlantic Pug Rescue, Inc. (MAPR). WHEREAS, MAPR is the legal owner of any pugs the volunteer transports, fosters, or handles (to include transporting the pug to and from obedience classes and training activities, working and handling the pug in public and private areas, and providing necessary care to ensure the pug’s safety), beginning on the date this agreement is signed. AND WHEREAS, the Volunteer has voluntarily contacted MAPR and has expressed an interest in working with dogs in the care and custody of MAPR. In consideration of MAPR’s agreement to allow the volunteer to view and/or interact with such dogs, the volunteer hereby, for his/her heirs, his/her personal representatives, and him/herself represent and warrant as follows: The volunteer is fully aware of the risks that dogs pose and have elected to view and/or interact with one or more dogs in the care of MAPR voluntarily. The volunteer knowingly assumes all risks that exposure to dogs may pose, including but not limited to serious bodily injury and/or death. THE VOLUNTEER HEREBY WAIVES, RELEASES, DISCHARGES, HOLD HARMLESS, AND PROMISES TO INDEMNIFY AND NOT TO BRING SUIT AGAINST MAPR, its directors, officers, volunteers, staff, and all other agents, and attorneys for any of the referenced parties, and any other parties acting for, or on behalf of any of the referenced parties, from any and all rights and claims which the volunteer has or which may hereafter accrue to the volunteer and from any and all damages which may be sustained by the volunteer directly or indirectly in connection with, or arising out of, the volunteer’s exposure to such dogs. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed this _______day of _ _______________, 20__. ____________________________ Signature of Applicant Directory: files files -> Answer True False 2 points Question 2 files -> Integer programming and game theory files -> 4 Integer Programming files -> Bpa vehicle Window Repair Scenario #1 task: Procure vehicle window relacement. Objective files -> Pop Warner History files -> North Carolina Inclusion Initiative Mapping Where Children with ieps are Being Served Purpose files -> Fall 2013 Spring 2014 Program Data: Standard 1 Exhibit 4d files -> Hanban – asia society confucius classrooms network 2010 request for proposal files -> Northern England’s set-jetting locations Download 33.18 Kb. Share with your friends:
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